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PIK3CA testing in hormone receptor-positive/HER2-negative metastatic breast cancer: real-world data from Italian molecular pathology laboratories

    Francesco Pepe‡

    Department of Public Health, Federico II University of Naples, 80131, Naples, Italy

    ‡Authors contributed equally

    Search for more papers by this author

    ,
    Konstantinos Venetis‡

    Division of Pathology, European Institute of Oncology IRCCS, 20141, Milan, Italy

    ‡Authors contributed equally

    Search for more papers by this author

    ,
    Giulia Cursano

    Division of Pathology, European Institute of Oncology IRCCS, 20141, Milan, Italy

    ,
    Chiara Frascarelli

    Division of Pathology, European Institute of Oncology IRCCS, 20141, Milan, Italy

    Department of Oncology & Hemato-Oncology, University of Milan, 20122, Milan, Italy

    ,
    Pasquale Pisapia

    Department of Public Health, Federico II University of Naples, 80131, Naples, Italy

    ,
    Davide Vacirca

    Division of Pathology, European Institute of Oncology IRCCS, 20141, Milan, Italy

    ,
    Claudia Scimone

    Department of Public Health, Federico II University of Naples, 80131, Naples, Italy

    ,
    Alessandra Rappa

    Division of Pathology, European Institute of Oncology IRCCS, 20141, Milan, Italy

    ,
    Gianluca Russo

    Department of Public Health, Federico II University of Naples, 80131, Naples, Italy

    ,
    Eltjona Mane

    Division of Pathology, European Institute of Oncology IRCCS, 20141, Milan, Italy

    ,
    Fabio Pagni

    Center for Digital Medicine, Department of Medicine & Surgery, University Milan Bicocca, Monza (MB), Italy

    Molecular Pathology & Predictive Medicine PMMP Group, Italian Society of Pathology, SIAPeC, Italy

    ,
    Isabella Castellano

    Pathology Unit, Department of Medical Sciences, City of Health and Science University Hospital, University of Turin, 10126, Turin, Italy

    Breast Pathology GIPaM Group, Italian Society of Pathology, SIAPeC, Italy

    ,
    Giancarlo Troncone

    Department of Public Health, Federico II University of Naples, 80131, Naples, Italy

    ,
    Carmine De Angelis

    Department of Clinical Medicine & Surgery, University Federico II, 80131, Naples, Italy

    ,
    Giuseppe Curigliano

    Department of Oncology & Hemato-Oncology, University of Milan, 20122, Milan, Italy

    Division of New Drugs & Early Drug Development, European Institute of Oncology, IRCCS, 20141, Milan, Italy

    ,
    Elena Guerini-Rocco

    Division of Pathology, European Institute of Oncology IRCCS, 20141, Milan, Italy

    Department of Oncology & Hemato-Oncology, University of Milan, 20122, Milan, Italy

    Molecular Pathology & Predictive Medicine PMMP Group, Italian Society of Pathology, SIAPeC, Italy

    ,
    Umberto Malapelle§

    *Author for correspondence: Tel.: +39 081 746 3674;

    E-mail Address: umberto.malapelle@unina.it

    Department of Public Health, Federico II University of Naples, 80131, Naples, Italy

    Molecular Pathology & Predictive Medicine PMMP Group, Italian Society of Pathology, SIAPeC, Italy

    &
    Nicola Fusco§

    Division of Pathology, European Institute of Oncology IRCCS, 20141, Milan, Italy

    Department of Oncology & Hemato-Oncology, University of Milan, 20122, Milan, Italy

    Molecular Pathology & Predictive Medicine PMMP Group, Italian Society of Pathology, SIAPeC, Italy

    Breast Pathology GIPaM Group, Italian Society of Pathology, SIAPeC, Italy

    Published Online:https://doi.org/10.2217/pgs-2023-0238

    Introduction:PIK3CA gene mutations occur in approximately 40% of hormone receptor-positive/HER2-negative (HR+/HER2) metastatic breast cancers (MBCs), electing them to targeted therapy. Testing PIK3CA status is complex due to selection of biological specimen and testing method. Materials & methods: This work investigates real-life experience on PIK3CA testing in HR+/HER2 MBC. Clinical, technical and molecular data on PIK3CA testing were collected from two referral laboratories. Additionally, the results of a nationwide PIK3CA survey involving 116 institutions were assessed. Results: Overall, n = 35 MBCs were PIK3CA-mutated, with mutations mostly occurring in exons 9 (n = 19; 51.4%) and 20 (n = 15; 40.5%). The nationwide survey revealed significant variability across laboratories in terms of sampling methodology, technical assessment and clinical report signing healthcare figures for PIK3CA molecular testing in diagnostic routine practice. Conclusion: This study provides insights into the real-world routine of PIK3CA testing in HR+/HER2 MBC and highlights the need for standardization and networking in predictive pathology.

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