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This combination therapy consists of alpelisib, L-NMMA (tilarginine), and nab-paclitaxel. It is being evaluated in a Phase II clinical trial sponsored by The Methodist Hospital Research Institute for the treatment of HER2-negative metaplastic breast cancer (MpBC) and triple-negative breast cancer (TNBC). Alpelisib is an orally bioavailable, alpha-specific inhibitor of Class I phosphatidylinositol 3-kinase (PI3K). L-NMMA is a pan-nitric oxide synthase (NOS) inhibitor that targets the inducible NOS (iNOS) pathway, which is often upregulated in MpBC and contributes to chemoresistance. Nab-paclitaxel is an albumin-bound nanoparticle formulation of the taxane chemotherapy agent paclitaxel. The rationale for the triple combination is to overcome resistance mechanisms in aggressive breast cancer subtypes by simultaneously inhibiting the PI3K/Akt pathway and nitric oxide production while delivering cytotoxic chemotherapy.
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