alpelisib + dapagliflozin + fulvestrant + metformin

This is a combination therapy consisting of four medications used together for the treatment of HR+, HER2-, PIK3CA mutant metastatic breast cancer. Alpelisib is a selective PI3K inhibitor that targets the p110α isoform, blocking the PI3K/AKT/mTOR pathway which is often hyperactivated in breast cancer. Dapagliflozin is an SGLT2 inhibitor that helps manage alpelisib-induced hyperglycemia, a common side effect. Fulvestrant is an estrogen receptor antagonist that blocks estrogen receptors in breast cancer cells, preventing estrogen-stimulated tumor growth. Metformin is an antidiabetic medication that, when combined with dapagliflozin, helps normalize blood glucose levels during alpelisib treatment while maintaining the antitumor efficacy of alpelisib.