SAFIR PI3K is an open-label multicenter phase II randomized trial, comparing alpelisib plus
fulvestrant to maintenance chemotherapy in patient PIK3CA mutated with HR+/Her2- metastatic
breast cancer who do not present progressive disease after 6-8 cycles of 1st or second line
The primary objective is to determine whether treatment with alpelisib plus fulvestrant
prolongs progression-free survival (PFS) compared to maintenance chemotherapy in patients
PIK3CA mutated with hormone receptor positive (HR+), HER2-negative advanced breast cancer,
who do not present a progressive disease after 6-8 cycles of chemotherapy.
1. Women (or men) with histologically confirmed metastatic breast cancer.
2. Hormone receptor positive (HR+) and no Her2 over-expression, according to local
3. Presence of PIK3CA mutation on exon 9 or 20, determined on metastatic tissue specimen
(frozen or FFPE) or plasma (ctDNA). Eligible plasma should have been collected at time
of metastatic disease progression and before to initiating chemotherapy.
4. Patient's disease is resistant to endocrine therapy (defined either as a relapse or
progression occurred during endocrine therapy, whatever the line, or less than 12
months after the end of endocrine therapy in adjuvant context).
5. Patients who received 6 to 8 cycles of a first line chemotherapy, or patients who
received 6 to 8 cycles of a first line stopped for progression followed by 6 to 8
cycles of a 2nd line chemotherapy, and who are presenting a stable or a responding
disease at the time of randomization (4 full cycles of chemotherapy are accepted if
stopped for toxicity reasons)
6. Age ≥ 18 years
7. WHO Performance Status 0/1
8. Presence of measurable or evaluable disease according to RECIST criteria v1.1
9. Patients will have had a wash-out period of at least 14 days for weekly (except
monoclonal antibodies) or daily chemotherapies or 28 days for other chemotherapies
from last chemotherapy administration prior to randomization and should have recovered
from all residual toxicities (grade ≤1), excluding alopecia.
10. Patient has adequate bone marrow and organ function as defined by the following
1. Absolute Neutrophil Count (ANC) ≥ 1.5 x 109/L
2. Platelets ≥ 100 x 109/L
3. Hemoglobin ≥ 9.0 g/dL
4. INR ≤ 1.5
5. Potassium, magnesium and calcium (corrected for albumin), within normal limits
for the institution, or ≤ Grade 1 severity according to NCI-CTCAE version 4.03 if
judged clinically not significant by the investigator
6. Serum creatinine ≤ 1.5 x ULN or creatinine clearance ≥ 50 mL/min (Measured or
calculated by Cockroft and Gault formula)
7. Total serum bilirubin ≤ ULN (or ≤ 1.5 x ULN if liver metastases are present; or
total bilirubin ≤ 3.0 x ULN with direct bilirubin within normal range in patients
with well documented Gilbert's Syndrome)
8. Alanine aminotransferase (AST) and aspartate aminotransferase (ALT) ≤ 2.5 ULN (or
< 5.0 x ULN if liver metastases are present)
9. Fasting plasma glucose (FPG) ≤ 140mg/dL or ≤ 7.7 mmol/L* and Glycosylated
Hemoglobin (HbA1c)≤ 6.4% (both criteria have to be met).
- For patients with FPG ≥ 100 mg/dL or HbA1c ≥5.7% (i.e. threshold for
pre-diabetes) at baseline, recommend lifestyle changes according to ADA
guidelines, i.e. dietary advice (e.g. small frequent meals, low carbohydrate
content, high fiber, balancing carbohydrate intake over the course of the
day, three small meals and 2 small snacks rather than one large meal) and
exercise. A consultation with a diabetologist is highly recommended
11. Provision of signed and dated, written informed consent prior to any study specific
procedures, sampling and analysis
12. Patient with social insurance coverage.
1. Spinal cord compression or symptomatic or progressive brain metastases (unless
asymptomatic or treated and stable without steroids during the last 30 days).
2. Patient has received more than 2 previous lines of chemotherapy for metastatic disease
3. Prior exposure to anthracyclines or mitoxantrone with cumulative exposure in excess of
360 mg/m² for doxorubicin, 720 mg/m² for epirubicin, or 72 mg/m² for mitoxantrone.
4. In the Investigator's judgment, patient has a life expectancy < 3 months .
5. Disease progression occuring before randomization.
6. Patient has received prior treatment with any PI3K or AKT inhibitor (mTOR inhibitors
7. Patient has history of hypersensitivity to any drugs or metabolites of similar
chemical classes as alpelisib, or history of hypersensitivity to active or inactive
excipients of any other study treatment.
8. Patient has not recovered to grade 1 or better (except alopecia) from related side
effects of any prior antineoplastic therapy
9. Patient has received radiotherapy ≤ 4 weeks or limited field radiation for palliation
≤ 2 weeks prior to randomization, and who has not recovered to grade 1 or better from
related side effects of such therapy (with the exception of alopecia) or from whom ≥
25% of the bone marrow was irradiated
10. Patient has participated to another clinical study with an investigational product
during the last 30 days.
11. Patient has had major surgery within 14 days prior to starting study treatment or has
not recovered from major side effects
12. Patient is currently receiving or has received systemic corticosteroids ≤ 2 weeks
prior to starting study treatment, or has not fully recovered from side effects of
13. Patients with an established diagnosis of diabetes mellitus type I or not controlled
type II, or documented steroid induced diabetes mellitus
14. Patient who necessitates to maintain the following drugs during study treatment :
- Drugs known to be strong inhibitors or inducers of isoenzyme CYP3A4 including
herbal medications (list of prohibited CYP3A4 inhibitors and inducers provided in
- Drugs with a known risk to induce Torsades de Pointes (list of prohibited QT
prolonging drugs provided in Table 12) Note: The patient must have discontinued
strong inducers for at least one week and must have discontinued strong
inhibitors before the study treatment is initiated. Switching to a different
medication prior to starting study treatment is allowed.
15. Patient is currently receiving warfarin or other coumarin derived anti-coagulant for
treatment, prophylaxis or otherwise. Therapy with heparin, low molecular weight
heparin (LMWH), or fondaparinux is allowed.
16. Patients who have other concurrent severe or uncontrolled medical conditions that
would, in the Investigator's judgment, contraindicate patient participation in the
individual patient program (eg. active or uncontrolled severe infection, chronic
active hepatitis, immuno-compromised, acute or chronic pancreatitis, uncontrolled high
blood pressure, interstitial lung disease, etc.)
17. Patient has currently documented pneumonitis
18. Patient has a known history of HIV infection (testing not mandatory)
19. Patient has any of the following cardiac abnormalities:
- symptomatic congestive heart failure
- history of documented congestive heart failure (New York Heart Association
functional classification III-IV), documented cardiomyopathy
- Left Ventricular Ejection Fraction (LVEF) <50% as determined by Multiple Gated
acquisition (MUGA) scan or echocardiogram (ECHO)
- myocardial infarction ≤ 6 months prior to enrolment
- unstable angina pectoris
- serious uncontrolled cardiac arrhythmia
- symptomatic pericarditis
- QTcF > 480 msec on the baseline ECG (using the QTcF formula) currently receiving
treatment with medication that has a known risk to prolong the QT interval or
inducing Torsades de Pointes, and the treatment cannot be discontinued or
switched to a different medication prior to starting study treatment (list of
prohibited QT prolonging drugs provided in Table 12)
20. Patient has impairment of gastrointestinal (GI) function or GI disease that may
significantly alter the absorption of any study treatment (e.g., ulcerative diseases,
uncontrolled nausea, vomiting, diarrhea, malabsorption syndrome, or small bowel
21. Patient had previous or current malignancies of other histologies within the last 5
years, with the exception of in situ carcinoma of the cervix, and adequately treated
basal cell or squamous cell carcinoma of the skin.
22. Pregnant or nursing (lactating) women.
23. Patient who does not accept to comply with highly effective contraception methods
during the study treatment and through the duration as defined below after the final
dose of study treatment:
- Sexually active males should use a condom during intercourse while taking drug
and for at least 4 weeks after the final dose of study treatment and should not
father a child in this period.
- Women of child-bearing potential must use highly effective contraception during
study treatment and for at least 4 weeks after the final dose of study treatment
and until resumption of menses (if longer than 4 weeks).
24. Patient has a history of non-compliance to medical regimen or inability to grant
25. Individuals deprived of liberty or placed under the authority of a tutor