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Spotlight on fulvestrant in hormone receptor-positive metastatic breast cancer in postmenopausal women with disease progression following antiestrogen therapy

  • Adis Spotlight
  • Published:
American Journal of Cancer

Abstract

Fulvestrant (Faslodex®) is a novel estrogen receptor (ER) antagonist that competitively binds to the ER with a much greater affinity than that of tamoxifen. The downregulation of cellular levels of the ER protein results in complete abrogation of estrogen-sensitive gene transcription. This distinct mechanism of action ensures a lack of cross resistance with other hormonal agents and, in contrast to tamoxifen, fulvestrant has no known estrogen-agonist effects.

Fulvestrant is administered via monthly intramuscular injections (250mg) and is recommended for the treatment of hormone receptor-positive metastatic breast cancer in postmenopausal women with disease progression following antiestrogen therapy.

The efficacy of fulvestrant was similar to that of the aromatase inhibitor anastrozole (1 mg/day) in two, well designed studies in postmenopausal women with locally advanced or metastatic breast cancer that had progressed during prior antiestrogen therapy. Time to disease progression (primary endpoint) and treatment failure, rates of objective response and clinical benefit, overall survival, and quality of life were similar in patients treated with fulvestrant or anastrozole. In retrospective noninferiority analyses, fulvestrant was at least as effective as anastrozole in all randomized patients, and in those with or without visceral metastases.

Fulvestrant is generally well tolerated and was tolerated as well as anastrozole in clinical trials. Treatment-related adverse events were mostly mild to moderate and led to treatment withdrawal in about 1% of patients who received fulvestrant or anastrozole. The main adverse effects associated with therapy are nausea, asthenia, pain, vasodilation, and headache.

In conclusion, monthly intramuscular injections of fulvestrant are at least as effective and as well tolerated as oral anastrozole once daily in the treatment of postmenopausal women with advanced breast cancer that has progressed on prior antiestrogen therapy. Because of a different mode of action to that of other hormonal agents, fulvestrant is effective in the treatment of tamoxifen-resistant disease and, unlike tamoxifen, has no known estrogen agonist effects. Thus, fulvestrant provides an effective and well tolerated option for the treatment of hormone receptor-positive metastatic breast cancer in postmenopausal women with disease progression following antiestrogen therapy.

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Notes

  1. The use of trade names is for product identification purposes only and does not imply endorsement.

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Acknowledgments

The full text article in Drugs 2004; 64 (6): 633-648 was reviewed by: M. Baum, Department of Surgery, University College London, London, UK; R.W. Blamey, Nottingham Breast Institute, City Hospital, Nottingham, UK; A.U. Buzdar, Department of Breast Medical Oncology, M.D. Anderson Cancer Center, University of Texas, Houston, Texas, USA; A. Howell, Department of Medical Oncology, Christie CRC Research Centre, Christie Hospital NHS Trust, Manchester, UK; I. Vergote, Department of Gynaecological Oncology, University Hospitals, Leuven, Belgium.

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Authors and Affiliations

  1. Adis International Inc., 770 Township Line Road, Suite 300, Yardley, PA, 19067, USA

    Kate McKeage, Monique P. Curran & Greg L. Plosker

Authors
  1. Kate McKeage
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  2. Monique P. Curran
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  3. Greg L. Plosker
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Correspondence to Kate McKeage.

Additional information

This Spotlight is derived from abstract and summary text of an Adis Drug Evaluation originally published in full in Drugs 2004; 64 (6) 633–648. Reviewers of the original full text article are listed in the Acknowledgments section.

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McKeage, K., Curran, M.P. & Plosker, G.L. Spotlight on fulvestrant in hormone receptor-positive metastatic breast cancer in postmenopausal women with disease progression following antiestrogen therapy. Am J Cancer 3, 267–270 (2004). https://doi.org/10.2165/00024669-200403040-00008

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