[donocco]

Piqray (Alpelisib) is approved for Estrogen positive, Her 2 Neu negative postmenopausal
metastatic breast cancer. The dosage is 300mg (two 150mg capsules daily. If side effects become evident (they are common) the dosage can be reduced to 250mg daily and if this doesnt reduce the side effects the dosage can be lowered further to 200mg a day. The drug comes in 50mg, 100mg, and 150mg capsules. If the side effects are still severe at a dosage of 200mg daily, the drug should be discontiued.

Increases in blood sugar are very common and can be severe, as high as blood sugars
of 500mg percent. Antidiabetic drugs like Metformin, Actos and Januvia can be given to lower the blood sugar. Also the dosage of PiQray can be reduced. If the blood sugar doesnt drop to 160mg percent after 21 days, the drug is to be Dcd.

There can be severe diarrhea also. Any degree of diarrhea is very common, and the treatment is Imodium plus oral fluids. Once again the dosage can be lowered and if the problem continues, the drug should be discontinued.

Skin rashes are common and can progress to serious conditions like Steven Johnson Syndrome, so any kind of skin lesion has to be seriously watched.

Although rare, there can be Pneumonitis, so symptoms like cough and problems breathing have to be carefully monitired

Fatigue is very common as is nausea, loss of appetite, weight loss, stomatitis and hair loss. Usually the hair loss is not too severe.

There can be elevations of liver enzymes, decreased lymphocye count and loss of Calcium and Magesium.

Paul