205 Participants Needed

Alpelisib for Overgrowth Spectrum

(EPIK-P2 Trial)

Recruiting at 50 trial locations
NP
Overseen ByNovartis Pharmaceuticals
Prior Safety DataThis treatment has passed at least one previous human trial
Breakthrough TherapyThis drug has been fast-tracked for approval by the FDA given its high promise
Approved in 2 JurisdictionsThis treatment is already approved in other countries

Trial Summary

What is the purpose of this trial?

This is a prospective Phase II multi-center study with an initial 16-week, randomized, double-blind, placebo-controlled period, followed by two extension periods to assess the efficacy, safety and pharmacokinetics (PK) of alpelisib in pediatric and adult patients with PIK3CA-related overgrowth spectrum (PROS)

Do I need to stop my current medications to join the trial?

The trial requires you to stop taking strong inducers of CYP3A4 or inhibitors of breast cancer resistance protein (BCRP) at least 7 days before starting the treatment. Other medications are not specifically mentioned, so consult with the trial team for more details.

Will I have to stop taking my current medications?

The trial requires that you stop taking strong inducers of CYP3A4 or inhibitors of breast cancer resistance protein (BCRP) at least 7 days before starting the treatment. If you are on these medications, you will need to discontinue them before participating.

What data supports the idea that Alpelisib for Overgrowth Spectrum is an effective drug?

The available research shows that Alpelisib was approved by the FDA for treating PIK3CA-related Overgrowth Spectrum (PROS) based on a study where 27% of patients had a significant reduction in the size of their growths after 24 weeks. Additionally, 60% of those who responded to the treatment maintained their improvement for at least 12 months. This suggests that Alpelisib can be effective in managing symptoms of PROS.12345

What data supports the effectiveness of the drug Alpelisib for treating PIK3CA-related overgrowth spectrum (PROS)?

Alpelisib has been shown to be effective for PIK3CA-related overgrowth spectrum (PROS), with 27% of patients experiencing a significant reduction in lesion size after 24 weeks, and 60% of those responders maintaining the benefit for at least 12 months.12345

What safety data is available for Alpelisib?

Alpelisib, also known as Piqray, has been evaluated for safety in various settings. In the treatment of PIK3CA-related overgrowth spectrum (PROS), common adverse reactions (≥10%) included diarrhea, stomatitis, and hyperglycemia. In breast cancer patients, particularly older ones, it has shown an unusual adverse event profile. Factors such as drug exposure duration and maximum-tolerated dose can vary, affecting clinical response and safety outcomes.23567

Is Alpelisib safe for humans?

Alpelisib has been approved for use in breast cancer and PIK3CA-related overgrowth spectrum (PROS), with common side effects including diarrhea, mouth sores, and high blood sugar. It has been studied in both clinical trials and real-world settings, showing some adverse reactions but generally considered safe for its approved uses.23567

Is the drug Alpelisib (Piqray) a promising treatment for Overgrowth Spectrum?

The provided research articles do not contain information about Alpelisib (Piqray) or its effectiveness for Overgrowth Spectrum, so we cannot determine if it is a promising treatment based on this data.89101112

How is the drug Alpelisib unique for treating Overgrowth Spectrum?

Alpelisib (Piqray) is unique because it specifically targets the PI3K pathway, which is often involved in overgrowth conditions, offering a targeted approach that differs from more general treatments. This drug is typically used in cancer treatments, but its application in Overgrowth Spectrum is novel, as there are no standard treatments for this condition.89101112

Research Team

NP

Novartis Pharmaceuticals

Principal Investigator

Novartis Pharmaceuticals

Eligibility Criteria

This trial is for pediatric and adult patients with PIK3CA-related Overgrowth Spectrum (PROS) who have at least one measurable lesion over 2 cm confirmed by MRI. Participants must be able to provide a tissue sample, have stable blood sugar levels, and not have had previous treatment with alpelisib or similar drugs. Those with isolated macrodactyly, skin nevus/nevi, macroencephaly without other lesions, recent radiation or surgery in the area of interest are excluded.

Inclusion Criteria

Signed informed consent and assent (when applicable) from the patient, parent, legal authorized representative or guardian prior to any study related screening procedures are performed
For China only: Tissue sample collection and biomarker assessments are not applicable.
I have PROS with worsening symptoms and a confirmed measurable lesion.
See 6 more

Exclusion Criteria

I have not had major surgery within the last 3 months.
I have only large fingers/toes, skin moles, or an enlarged head without other PROS-related issues.
I have not been treated with alpelisib or similar drugs for more than 2 weeks.
See 7 more

Timeline

Screening

Participants are screened for eligibility to participate in the trial

6 weeks

Core Treatment

Participants undergo a 16-week randomized, double-blind, placebo-controlled treatment period

16 weeks
Regular visits as per protocol

Extension Period

Participants continue treatment in an open-label setting for an additional 24 weeks

24 weeks

Long-term Extension

Participants may continue treatment for up to approximately 5 years

Up to 5 years

Follow-up

Participants are monitored for safety and effectiveness after treatment

4 weeks

Treatment Details

Interventions

  • Alpelisib
  • Placebo
Trial OverviewThe study tests the effectiveness and safety of Alpelisib compared to a placebo in treating PROS. Initially, there's a 16-week blind phase where neither doctors nor participants know who gets Alpelisib or placebo. After that period, all may receive Alpelisib during extension periods while monitoring how their bodies absorb the drug.
Participant Groups
7Treatment groups
Experimental Treatment
Placebo Group
Group I: Pediatric cohort (group 5: 6-17 years old)-Alpelisib FCTExperimental Treatment1 Intervention
Pediatric participants (6 to 17 year old) will receive 125 mg alpelisib film-coated (FCT) once daily, in an open-label setting.
Group II: Pediatric cohort (group 4: 2 to 5 years old)- Alpelisib FCTExperimental Treatment1 Intervention
Pediatric participants (2 to 5 years old) will receive 50 mg of alpelisib film-coated tablets (FCT) once daily in an open-label setting.
Group III: Pediatric cohort (group 3: 0 to 5 years old)- Alpelisib granulesExperimental Treatment1 Intervention
Pediatric participants (0 to 5 years old) will receive alpelisib granules formulation with an age-dependent starting dose (\<1 month: 20 mg every other day; 1 to \<6 months: 20 mg daily; 6 to \<2 years: 40 mg daily; 2 to \<6 years: 50 mg daily).
Group IV: Pediatric cohort (group 2: 6 to 17 years old) -AlpelisibExperimental Treatment1 Intervention
During double-blind randomized study period (from baseline up to Week 16, pediatric participants (6 to 17 years old) will be randomized to receive alpelisib (50 mg, oral, once daily). After Week 16, participants will continue their active treatment at the same dose level.
Group V: Adult cohort (group 1)- AlpelisibExperimental Treatment1 Intervention
During double-blind randomized study period (from baseline up to Week 16), adult participants will be randomized to receive alpelisib (125 mg, oral, once daily). After Week 16, participants will continue their active treatment at the same dose level.
Group VI: Adult cohort (group 1)- PlaceboPlacebo Group2 Interventions
During double-blind randomized study period (from baseline up to Week 16), adult participants will be randomized to receive placebo. After Week 16, participants will be switched to active treatment with alpelisib at the placebo dose level received at the end of the placebo period.
Group VII: Pediatric cohort (group 2: 6 to 17 years old)-PlaceboPlacebo Group2 Interventions
During double-blind randomized study period (from baseline up to Week 16), pediatric participants (6 to 17 years old) will be randomized to receive Placebo. After Week 16, participants will be switched to active treatment with alpelisib at the placebo dose level received at the end of the placebo period.

Alpelisib is already approved in United States, European Union for the following indications:

🇺🇸
Approved in United States as Piqray for:
  • Hormone receptor-positive, HER2-negative, PIK3CA-mutated, advanced or metastatic breast cancer following progression on or after an endocrine-based regimen
🇪🇺
Approved in European Union as Piqray for:
  • Hormone receptor-positive, HER2-negative, PIK3CA-mutated, locally advanced or metastatic breast cancer in combination with fulvestrant

Find a Clinic Near You

Who Is Running the Clinical Trial?

Novartis Pharmaceuticals

Lead Sponsor

Trials
2,963
Recruited
4,275,000+
Founded
1996
Headquarters
Basel, Switzerland
Known For
Precision medicine
Top Products
Gleevec, Cosentyx, Entresto, Kisqali
Dr. Vas Narasimhan profile image

Dr. Vas Narasimhan

Novartis Pharmaceuticals

Chief Executive Officer since 2018

MD from Harvard Medical School

Dr. Shreeram Aradhye profile image

Dr. Shreeram Aradhye

Novartis Pharmaceuticals

Chief Medical Officer since 2021

MD

Findings from Research

Alpelisib (PIQRAY®) is the first PI3K inhibitor approved for treating hormone receptor-positive metastatic breast cancer with PIK3CA mutations, showing promising clinical results that support its use in overcoming endocrine resistance.
The review highlights the pharmacodynamic and pharmacokinetic properties of alpelisib, along with safety and efficacy data from the Phase III SOLAR-1 trial, which led to its FDA approval, indicating its potential as a tailored treatment option.
Alpelisib in the treatment of metastatic HR+ breast cancer with PIK3CA mutations.Mavratzas, A., Marmé, F.[2021]
In a study of 51 older breast cancer patients (median age 71), alpelisib was associated with significant adverse events, particularly hyperglycemia, which affected 37 patients and led to hospitalizations for 5.
Despite the adverse effects, there is potential for older patients to benefit from alpelisib if the management of these side effects, especially hyperglycemia, can be improved.
Observations with alpelisib in older patients (≥ 65 year of age) with breast cancer in a non-clinical trial setting.Almodallal, Y., Le-Rademacher, JG., Cook, KD., et al.[2022]
Alpelisib (Piqray™) is an oral PI3K inhibitor specifically targeting PI3Kα, showing efficacy in treating hormone receptor-positive, HER2-negative breast cancer in patients with a PIK3CA mutation.
The drug has been approved in the USA for use in combination with fulvestrant, marking a significant milestone in its development for breast cancer treatment.
Alpelisib: First Global Approval.Markham, A.[2020]

References

Alpelisib in the treatment of metastatic HR+ breast cancer with PIK3CA mutations. [2021]
Observations with alpelisib in older patients (≥ 65 year of age) with breast cancer in a non-clinical trial setting. [2022]
Alpelisib: First Global Approval. [2020]
The PI3K&#945; Inhibitor Alpelisib Has Activity in PIK3CA-altered Tumors. [2019]
FDA Approval Summary: Alpelisib for PIK3CA-related Overgrowth Spectrum (PROS). [2023]
Pharmaceutical Approval Update. [2020]
Factors leading to alpelisib discontinuation in patients with hormone receptor positive, human epidermal growth factor receptor-2 negative breast cancer. [2022]
The targetable kinase PIM1 drives ALK inhibitor resistance in high-risk neuroblastoma independent of MYCN status. [2021]
Diagnosis and Treatment of Advanced ALK Rearrangement-Positive Non-Small-Cell Lung Cancer in Portugal: Results of a National Questionnaire. [2023]
10.United Statespubmed.ncbi.nlm.nih.gov
Genomic alterations of anaplastic lymphoma kinase may sensitize tumors to anaplastic lymphoma kinase inhibitors. [2021]
Classical ALK G1202R resistance mutation was identified in a lung adenocarcinoma patient with rare LOC388942-ALK fusion after sequential treatment with ALK-TKIs and anlotinib: a case report. [2022]
SPP1 overexpression is associated with poor outcomes in ALK fusion lung cancer patients without receiving targeted therapy. [2022]