Fulvestrant for hormone-sensitive metastatic breast cancer

For postmenopausal women with advanced hormone-sensitive breast cancer, fulvestrant is at least as effective and safe as the comparator endocrine therapies. However, fulvestrant may be potentially more effective than current therapies when given at a dose of 500 mg.

Summary

A Cochrane review included 9 studies with a total of 4514 subjects. Fulvestrant is a selective oestrogen receptor down-regulator (SERD) used in hormone-sensitive locally advanced or metastatic breast cancer in postmenopausal women. Overall results for the primary endpoint of progression-free survival (PFS), mortality, or toxicity indicated that women receiving fulvestrant did at least as well as the control groups (other endocrine therapy) . In the one high-quality study that tested fulvestrant at the currently approved and now standard dose of 500 mg against anastrozole, women treated with fulvestrant 500 mg did better, with a hazard ratio (HR) for time to progressio of 0.66 (95% CI 0.47 to 0.93; n=205) and a HR for overall survival of 0.70 (95% CI 0.50 to 0.98; n=205). There was no difference in PFS whether fulvestrant was used in combination with another endocrine therapy or in the first- or second-line setting, when compared to control treatments: for monotherapy HR 0.97 (95% CI 0.90 to 1.04) versus HR 0.87 (95% CI 0.77 to 0.99) for combination therapy when compared to control, and HR 0.93 (95% CI 0.84 to 1.03) in the first-line setting and HR 0.96 (95% CI 0.88 to 1.04) in the second-line setting.

Clinical comments

Date of latest search: 7 July 2015

Ədəbiyyat

1. Lee CI, Goodwin A, Wilcken N. Fulvestrant for hormone-sensitive metastatic breast cancer. Cochrane Database Syst Rev 2017;(1):CD011093.