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01-08-2020 | Breast Cancer | Epidemiology

Dermatologic adverse events related to the PI3Kα inhibitor alpelisib (BYL719) in patients with breast cancer

Authors: Diana G. Wang, Dulce M. Barrios, Victoria S. Blinder, Jacqueline F. Bromberg, Pamela R. Drullinsky, Samuel A. Funt, Komal L. Jhaveri, Diana E. Lake, Tomas Lyons, Shanu Modi, Pedram Razavi, Michelle Sidel, Tiffany A. Traina, Linda T. Vahdat, Mario E. Lacouture

Published in: Breast Cancer Research and Treatment | Issue 1/2020

Abstract

Purpose

Rash develops in approximately 50% of patients receiving alpelisib for breast cancer, often requiring dose modifications. Here, we describe the clinicopathologic, laboratory, and management characteristics of alpelisib-related dermatologic adverse events (dAEs).

Methods

A single center-retrospective analysis was conducted. Data were abstracted from electronic medical records.

Results

A total of 102 patients (mean age 56 years, range 27–83) receiving alpelisib most frequently in combination with endocrine therapy (79, 77.5%) were included. We identified 41 (40.2%) patients with all-grade rash distributed primarily along the trunk (78%) and extremities (70%) that developed approximately within two weeks of treatment initiation (mean 12.8 ± 1.5 days) and lasted one-week (mean duration 7.1 ± 0.8 days). Of 29 patients with documented morphology of alpelisib-related dAEs, 26 (89.7%) had maculopapular rash. Histology showed perivascular and interface lymphocytic dermatitis. All-grade rash correlated with an increase in serum eosinophils from 2.7 to 4.4%, p < 0.05, and prophylaxis with non-sedating antihistamines (n = 43) was correlated with a reduction of grade 1/2 rash (OR 0.39, p = 0.09). Sixteen (84.2%) of 19 patients with grade 3 dAEs resulted in interruption of alpelisib, which were managed with antihistamines, topical and systemic corticosteroids. We did not observe rash recurrence in 12 (75%) patients who were re-challenged.

Conclusions

A maculopapular rash associated with increased blood eosinophils occurs frequently with alpelisib. While grade 3 rash leads to alpelisib therapy interruption, dermatologic improvement is evident with systemic corticosteroids; and most patients can continue oncologic treatment at a maintained or reduced dose upon re-challenge with alpelisib.

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Title: Dermatologic adverse events related to the PI3Kα inhibitor alpelisib (BYL719) in patients with breast cancer
Authors: Diana G. Wang
Dulce M. Barrios
Victoria S. Blinder
Jacqueline F. Bromberg
Pamela R. Drullinsky
Samuel A. Funt
Komal L. Jhaveri
Diana E. Lake
Tomas Lyons
Shanu Modi
Pedram Razavi
Michelle Sidel
Tiffany A. Traina
Linda T. Vahdat
Mario E. Lacouture
Publication date: 01-08-2020
Publisher: Springer US
Keywords: Breast Cancer
Breast Cancer
Published in: Breast Cancer Research and Treatment / Issue 1/2020
Print ISSN: 0167-6806
Electronic ISSN: 1573-7217
DOI: https://doi.org/10.1007/s10549-020-05726-y

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