Alpelisib (Piqray) for breast cancer: the complete patient guide

Alpelisib, sold under the brand name Piqray, is a targeted tablet for advanced or metastatic breast cancer that is hormone receptor positive and HER2-negative and carries a change, or mutation, in a gene called PIK3CA. Around four in ten of these cancers have such a mutation. The PIK3CA gene makes part of a growth signalling pathway known as PI3K. When the gene is mutated, the pathway stays switched on, which helps the cancer grow and resist hormone therapy. Alpelisib blocks this signal. It is taken once a day with food, together with fulvestrant, a hormone injection, usually after the cancer has grown during or after earlier hormone treatment. In the main study, called SOLAR-1, people with a PIK3CA mutation who took alpelisib with fulvestrant had their cancer controlled for roughly eleven months on average, compared with under six months with fulvestrant alone. A later study showed it can also help after a CDK4/6 inhibitor. Because the same pathway helps the body handle sugar, alpelisib commonly raises blood sugar, sometimes a lot. Rash, loose motions, mouth sores, tiredness and weight loss are also common. Most of these can be prevented or managed with regular checks, antihistamines, diabetes medicines and dose changes. Alpelisib does not make metastatic cancer go away, but for suitable people it is one useful step in a longer treatment plan.

A test decides eligibility

Only cancers with a PIK3CA mutation, found on a tissue or blood test, are treated with alpelisib.

Blood sugar needs planning

Your sugar is checked before starting and often during the early weeks.

It is taken with fulvestrant

Alpelisib tablets are paired with regular fulvestrant injections.

Alpelisib offers a meaningful gain for people with the right mutation, but it is a demanding treatment for some.

It controls, rather than removes, the cancer

The aim is longer control of metastatic disease and more time living well.

Side effects lead some people to stop

In studies, a noticeable share of people stopped because of side effects, most often high blood sugar or rash.

Newer options are emerging

Other medicines acting on the same pathway, such as inavolisib and capivasertib, are now used in some settings.

What this page cannot tell you

It cannot tell you whether alpelisib is the best next step for you. Your oncologist weighs your test results, health and priorities.

Many people carry on working, caring for family and enjoying daily life while on alpelisib, once the early weeks settle into a routine.

A daily rhythm

Take the tablet with a meal at the same time each day, and link it with a habit such as breakfast or dinner.

Food choices

Cutting back on sweets, sugary drinks, white rice and refined flour, and eating more vegetables, pulses and protein, helps keep sugar steady.

Skin and mouth care

Gentle soaps, moisturiser, sun protection and a soft toothbrush reduce skin and mouth problems.

Staying in touch

Report new symptoms early. Small problems are far easier to manage than severe ones.