Exceptional Clinical Response to Alpelisib in a Patient with Metastatic Breast Cancer with Hyperbilirubinemia and a PIK3CA Mutation

Abstract

In the era of personalized and precision medicine, the importance of next-generation sequencing in metastatic breast cancer has been increasingly recognized. This case highlights one such example in which a patient with heavily pretreated, hormone receptor-positive metastatic breast cancer was discovered to have a PIK3CA mutation and started on a PIK3 inhibitor with an exceptional response. This patient had been facing a visceral crisis with diffuse liver metastasis and hyperbilirubinemia. Alpelisib was able to achieve rapid disease control within a matter of weeks with clinical and objective laboratory improvement. To date, there has been no published data regarding the safety of alpelisib in patients with elevated bilirubin and this case report lends support to safety and efficacy in this situation.