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KINASE INHIBITOR
Piqray (alpelisib) is a prescription medication approved by the U.S. Food and Drug Administration (FDA) in combination with fulvestrant to treat adults with HR-positive, HER2-negative, PIK3CA-mutated advanced or metastatic breast cancer following progression on or after endocrine therapy.
These insights are based on 84 comments about Piqray from MyBCTeam members. These are the experiences of a small number of individuals and are not meant to be medical advice.
Piqray is a type of targeted therapy called a PI3K inhibitor. Phosphoinositide 3-kinase (PI3K) is a pathway that can help cells grow and survive. Piqray mainly blocks PI3K alpha.
Some breast cancers have a change, or mutation, in a gene called PIK3CA. This mutation can turn on the PI3K pathway. In studies using breast cancer models, Piqray blocked signals in this pathway and reduced tumor growth.
When Piqray was used with fulvestrant, the combination showed more anti-tumor activity than either medicine alone in models of HR-positive, PIK3CA-mutated breast cancer.
Doctors prescribe Piqray when adults have HR-positive, HER2-negative, advanced or metastatic breast cancer with a PIK3CA mutation after endocrine therapy has stopped working. It is used together with fulvestrant.
By targeting this pathway, the medication may help manage cancer growth.
Piqray is given as a tablet by mouth, usually once a day with food. It should be taken at about the same time each day and swallowed whole.
Treatment usually continues until the cancer gets worse or side effects become too difficult to manage.
The recommended dose of Piqray for breast cancer is 300 milligrams by mouth once daily with food, taken as two 150-milligram tablets.
It is used with 500 milligrams of fulvestrant, given on days 1, 15, and 29, and then once a month after that. Treatment usually continues until the cancer gets worse or side effects become unacceptable.
Doctors may pause treatment, lower the dose, or stop treatment if side effects are serious or too hard to manage.
This information is based on the prescribing information, but your healthcare provider may tailor your treatment plan. Always follow their guidance.
These insights are based on 84 comments about Piqray from MyBCTeam members.
Members who use Piqray often say it helps to stay in close contact with your care team, especially about blood sugar changes, stomach side effects, and dose adjustments. Many members also describe balancing side effects with treatment benefits while watching scans, lab results, and symptoms over time.
Watch your blood sugar closely and tell your doctor about changes.
“My sugar is very high, and that is one of the side effects of Piqray, so I’m not sure if my doctors are going to leave me on it.”
Ask your doctor about side effects that are hard to manage.
“I was on Piqray, which also caused diarrhea. Some days had to take 4 Imodium and Zofran.”
Talk to your doctor about dose changes if side effects continue.
“My oncologist took me off of the 300 milligrams and put me on 200 milligrams. I’m finally feeling a little better today and getting some strength.”
Keep up with labs, scans, and other follow-up appointments.
“My blood counts are good along with others they check with blood work. I get them done every two weeks.”
Give yourself time to adjust and take it one day at a time.
“Doing shots monthly and taking Piqray every day, it’s a struggle, but I’m here living day to day.”
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In clinical trials of Piqray used with fulvestrant for adults with HR-positive, HER2-negative, PIK3CA-mutated advanced or metastatic breast cancer after progression on or after endocrine therapy, the most common side effects occurred in at least 20 percent of people taking Piqray.
These side effects include:
Get medical help right away if you think you are having a serious reaction to Piqray.
Before starting Piqray, your doctor will test or check for:
Tell your doctor if you have any allergies to alpelisib or any ingredients in Piqray.
Tell your doctor about all medications you take, including prescription drugs, over-the-counter medicines, and supplements.
Do not take Piqray if you have had a serious allergic reaction to alpelisib or any of its ingredients.
If you miss a dose, take it with food within nine hours of when you usually take it. If more than nine hours have passed, skip that dose and take your next dose at the usual time.
If you vomit after taking Piqray, do not take another dose that day.
Piqray can cause fetal harm during pregnancy. If you can become pregnant, your doctor may give you a pregnancy test before you start treatment.
Females who can become pregnant should use effective birth control during treatment and for one week after the last dose. Males with female partners who can become pregnant should use condoms and effective birth control during treatment and for one week after the last dose.
Do not breastfeed during treatment with Piqray and for one week after the last dose. Piqray may also affect fertility.
These answers are fact-checked by our editorial staff.
How effective is Piqray?
In a clinical trial of people with HR-positive, HER2-negative, advanced or metastatic breast cancer with a PIK3CA mutation, Piqray plus fulvestrant delayed cancer worsening for a median of 11 months, compared with 5.7 months for placebo (an inactive treatment) plus fulvestrant.
The overall response rate (tumor shrinkage) was 35.7 percent with Piqray plus fulvestrant, compared with 16.2 percent with placebo plus fulvestrant. No benefit was seen in people whose tumors did not have a PIK3CA mutation.
Can Piqray cause high blood sugar in people with breast cancer?
Yes. High blood sugar was common in studies, reported in 65 percent of people taking Piqray, and severe high blood sugar occurred in some cases.
Before starting treatment, fasting blood glucose and HbA1c should be checked. HbA1c should be monitored every three months (or as instructed by your doctor), and blood sugar should be monitored at least once every week for the first two weeks, then at least once every four weeks.
Tell your healthcare provider right away if you have symptoms of high blood sugar.
Can Piqray cause rash or severe skin reactions in people with breast cancer?
Yes. Rash was reported in 52 percent of people taking Piqray plus fulvestrant, and severe skin reactions such as Stevens-Johnson syndrome, erythema multiforme, toxic epidermal necrolysis, and DRESS can occur.
If severe skin reactions are confirmed, Piqray should be stopped permanently and not restarted.
On MyBCTeam, people share their experiences with breast cancer, get advice, and find support from others who understand.
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