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We aim to elucidate the prognostic value of  PIK3CA  mutations and copy number (CN) gain ( PIK3CA -mut/gain) in hormone receptor-positive and HER2-negative (HR + /HER2−) breast cancer (BC). We analyzed primary HR + /HER2− BC from three publicly available datasets comprising over 2000 samples and assessed the associations with tumoral and clinical characteristics and outcome. Clinical benefit (CB) in alpelisib-treated patients from two studies including 46 patients was analyzed. About 8–10% of HR + /HER2− primary BC had  PIK3CA -mut/gain. In two of the datasets analyzed, among patients with  PIK3CA  mutant tumors, those with mut/gain had significantly worse outcome compared to those with CN neutral ( PIK3CA -mut/neut) and  PIK3CA -mut/gain remained an independent prognostic factor. CB of alpelisib-treated patients with  PIK3CA -mut/gain and  PIK3CA -mut/neut tumors was comparable.  PIK3CA  CN might help clarifying the prognostic and predictive role of  PIK3CA  mutations. Further studies are warranted.

PIK3CA co-occurring mutations and copy-number gain in hormone receptor positive and HER2 negative breast cancer