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Alpelisib (Piqray)

What is Alpelisib?

Alpelisib, marketed under the brand name Piqray, is a medication used to treat HR-positive, HER2-negative breast cancer that has spread to other parts of the body (metastatic breast cancer). It is specifically used in combination with letrozole (an aromatase inhibitor) for the treatment of breast cancer that has a PIK3CA mutation. Alpelisib works by targeting and inhibiting a protein called PI3K, which is involved in cancer cell growth and survival.

How Does Alpelisib Work?

Alpelisib is a PI3K inhibitor. PI3K is an enzyme that plays a crucial role in cell growth, survival, and metabolism. In some cancers, including breast cancer, this pathway becomes overactive, leading to uncontrolled cell growth. By blocking PI3K, Alpelisib helps slow or stop the growth of cancer cells, which can shrink tumors or prevent them from growing further.

How is Alpelisib Taken?

  • Form: Alpelisib is taken as a tablet by mouth.
  • Dosage: The recommended dose of alpelisib is 300 mg once a day.
  • Administration: Take alpelisib once a day with food, at the same time each day, to help you remember.
  • Swallowing the Tablet: Swallow the tablet whole with a glass of water. Do not crush, chew, or break the tablet.

Possible Side Effects

Alpelisib can cause side effects. Some of these side effects may be serious, and you should contact your healthcare provider if you notice any new or unusual symptoms.

Common Side Effects:

  • Diarrhea: Diarrhea is one of the most common side effects of alpelisib. Drink plenty of fluids and notify your doctor if diarrhea is severe or persistent.
  • Rash: A rash may develop, often on the face or upper body. If the rash is severe or doesn’t go away, inform your healthcare provider.
  • Nausea and Vomiting: You may feel nauseous or vomit, especially during the early stages of treatment. Taking anti-nausea medications can help manage these symptoms.
  • Mouth Sores: Alpelisib can cause painful sores or ulcers inside the mouth, which can make it difficult to eat or drink.
  • Fatigue: Many people experience tiredness or weakness, especially in the first few weeks of treatment. Rest and conserve your energy, but let your doctor know if fatigue becomes severe.

Serious Side Effects:

  • High Blood Sugar (Hyperglycemia): Alpelisib can cause an increase in blood sugar levels. Symptoms of high blood sugar may include excessive thirst, frequent urination, fatigue, or blurred vision. Your doctor will monitor your blood sugar regularly, and you may need treatment for diabetes while taking alpelisib.
  • Severe Skin Reactions: Rarely, alpelisib can cause severe skin reactions such as blistering, peeling, or severe rash. If you notice these symptoms, contact your doctor immediately.
  • Lung Problems: Alpelisib can sometimes cause lung issues, including difficulty breathing or persistent cough. Let your healthcare provider know if you experience these symptoms.
  • Low White Blood Cell Count (Neutropenia): Alpelisib can lower the number of white blood cells in your blood, which can increase the risk of infections. If you develop a fever, chills, or any signs of infection, seek immediate medical help.
  • Liver Problems: Alpelisib can affect liver function. Symptoms of liver problems include yellowing of the skin or eyes (jaundice), dark urine, or pain in the upper abdomen. Notify your doctor if you experience any of these symptoms.

Precautions Before Taking Alpelisib

Before starting alpelisib, inform your healthcare provider if you:

  • Have Diabetes or High Blood Sugar: Alpelisib can cause an increase in blood sugar levels, so it is especially important to monitor your blood sugar if you have diabetes or are at risk for diabetes.
  • Have Liver or Kidney Problems: Alpelisib may affect liver or kidney function, so your doctor may need to adjust your dose or monitor your function more closely.
  • Are Pregnant or Planning to Become Pregnant: Alpelisib can harm an unborn baby, so you should not take it if you are pregnant. It is important to use effective birth control while taking alpelisib and for 1 week after stopping the medication.
  • Are Breastfeeding: It is not known whether alpelisib passes into breast milk. You should not breastfeed while taking alpelisib.
  • Are Taking Other Medications: Some medications can interact with alpelisib. Make sure your doctor knows about all prescription and over-the-counter medications, vitamins, and herbal supplements you are taking.

What to Avoid While Taking Alpelisib

  • Grapefruit and Grapefruit Juice: Avoid consuming grapefruit or grapefruit juice, as they may increase the amount of alpelisib in your bloodstream, increasing the risk of side effects.
  • Live Vaccines: Do not receive live vaccines while taking alpelisib unless your healthcare provider gives you approval. Live vaccines may not be safe during treatment.
  • Infections: Alpelisib can weaken your immune system, making it easier to get infections. Wash your hands frequently and avoid close contact with people who have infections or illnesses.

Regular Monitoring

Your healthcare provider will monitor your health regularly during treatment with alpelisib, including:

  • Blood Tests: Your doctor will perform regular blood tests to check your blood sugar, liver function, and white blood cell count.
  • Blood Sugar: Alpelisib can affect blood sugar, so your doctor will monitor your blood sugar levels regularly.
  • Skin Monitoring: Since skin reactions are common, your doctor may check your skin regularly during treatment.
  • Lung Function: If you develop any respiratory symptoms, your doctor may perform tests to monitor your lung function.

When to Contact Your Doctor

Call your healthcare provider immediately if you experience any of the following:

  • High blood sugar symptoms: Excessive thirst, frequent urination, fatigue, or blurred vision.
  • Lung problems: Difficulty breathing or a persistent cough.
  • Severe skin reactions: Blistering, peeling, or severe rash.
  • Liver problems: Yellowing of the skin or eyes (jaundice), dark urine, or pain in the upper abdomen.
  • Signs of infection: Fever, chills, or sore throat.
  • Severe rash or mouth sores: Painful rash or sores inside your mouth that affect eating or drinking.

Disclaimer:

This handout is for educational purposes only and should not be considered medical advice. Always follow the instructions provided by your healthcare provider regarding treatment and care. For personalized advice, consult your healthcare provider or pharmacist.