Journal: NPJ breast cancer
The publication is a practical, toxicity-management focused review of capivasertib plus fulvestrant in HR-positive, HER2-negative advanced breast cancer with PIK3CA/AKT1/PTEN alterations, based on experience from the CAPItello‑291 trial and early real-world use.
Key points:
- Context: Capivasertib combined with fulvestrant significantly improves progression‑free survival in endocrine‑resistant, biomarker-selected disease, but its class‑typical toxicities—diarrhea, rash, and hyperglycemia—can affect adherence and continuity of therapy.
- Aim: To provide structured, practice-oriented guidance for prevention, early recognition, and management of these adverse events so patients can stay on treatment and derive maximal benefit.
- Diarrhea:
- Emphasizes early patient education and prompt initiation of anti‑diarrheals at first symptoms.
- Recommends hydration strategies, dietary modifications, and clear thresholds for dose interruption or reduction when symptoms persist or become severe.
- Rash:
- Recommends baseline skin assessment, prophylactic skin care (gentle cleansers, moisturizers, sun protection), and prompt treatment of early lesions.
- Describes when to introduce topical corticosteroids or systemic agents, and when to pause or adjust dosing based on severity.
- Hyperglycemia:
- Suggests baseline risk assessment (history of diabetes/metabolic syndrome, fasting glucose/HbA1c) and regular glucose monitoring after treatment initiation.
- Recommends early collaboration with primary care/endocrinology, diet and lifestyle counseling, and stepwise introduction/intensification of antihyperglycemic therapy where needed.
- Overarching strategies:
- Stress on pre-treatment counseling so patients expect and report side effects early.
- Use of standardized toxicity grading, clear algorithms for dose holds/reductions, and multidisciplinary involvement.
- The goal is to maintain dose intensity where feasible while preserving quality of life and safety.
Overall, the article functions as a practical guide to integrate capivasertib safely into routine practice by proactively managing its predictable toxicities.