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Alpelisib-induced severe interstitial lung disease: case report
Metehan Berkkan1, Cevat İlteriş Kıkılı2, Bahadır Köylü2
1Department of Internal Medicine, Koç University School of Medicine, Istanbul, Turkey.
Journal of Chemotherapy (Florence, Italy)
|January 2, 2026
Summary
Alpelisib, a PI3Kα inhibitor, treats advanced breast cancer but can cause rare pneumonitis. This case shows early recognition and management of alpelisib-induced pneumonitis are crucial for patient outcomes.
Area of Science:
- Oncology
- Pharmacology
Background:
- Alpelisib targets PI3Kα, improving outcomes in HR+, HER2-negative, PIK3CA-mutated advanced breast cancer.
- Serious toxicities, including pneumonitis, are rare but possible with alpelisib treatment.
- Hormone receptor-positive (HR+), HER2-negative breast cancer requires targeted therapies for advanced stages.
Purpose of the Study:
- To report a case of early-onset alpelisib-induced pneumonitis in a patient with PIK3CA-mutated breast cancer.
- To emphasize the importance of prompt diagnosis and management of drug-induced pneumonitis.
- To highlight potential toxicities associated with PI3Kα inhibitors.
Main Methods:
- Case report of a 79-year-old woman with advanced ER+/HER2- breast cancer.
- Treatment included surgery, anastrozole, ribociclib-fulvestrant, and subsequently alpelisib plus fulvestrant based on liquid biopsy.
- Diagnosis of pneumonitis was supported by clinical presentation, imaging, and bronchoalveolar lavage findings after alpelisib initiation.
Main Results:
- The patient developed acute dyspnea and hypoxemia two months after starting alpelisib 150 mg daily.
- Imaging revealed bilateral peripheral ground-glass opacities, and infectious work-up was negative.
- Discontinuation of alpelisib and corticosteroid treatment resulted in complete clinical and radiological resolution of pneumonitis.
Conclusions:
- Alpelisib-induced pneumonitis can occur early, even at a reduced dose.
- Early recognition and prompt management, including drug discontinuation and corticosteroid therapy, are essential for favorable outcomes.
- This case underscores the need for vigilance regarding rare but serious side effects of targeted cancer therapies.
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