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Published in: Breast Cancer Research and Treatment 1/2011

01-01-2011 | Clinical trial

Benefits of early and prolonged fulvestrant treatment in 848 postmenopausal advanced breast cancer patients

Authors: Mathias Warm, Ronald Kates, Friedrich Overkamp, Anke Thomas, Nadia Harbeck

Published in: Breast Cancer Research and Treatment | Issue 1/2011

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Abstract

Response to fulvestrant and survival in postmenopausal hormone-sensitive advanced breast cancer was investigated within a non-randomized, In-Practice Evaluation Program, with the aim of optimizing treatment decisions. 848 patients (median age 64 years; 52% co-morbidity; 78% prior palliative therapy; median 4 prior regimens) received monthly fulvestrant injections (250 mg/month) and were followed-up three-monthly for 9 months. Clinical benefit (PFS ≥ 24 weeks) occurred in 532/848 (62.7%); stable disease (SD) in 627/848 patients (74%), including 62 complete and 177 partial responses. Best response was delayed in 115 patients. Estimated 9-month overall survival (OS) was 89%; 9-month event-free survival (EFS) was 71%. Indicators of disease aggressiveness affected response and survival, but number of fulvestrant cycles was the key OS and EFS determinant. The patients with SD at 3 months benefitted from continued fulvestrant. Excluding deaths, 7 serious adverse events occurred (none attributable to fulvestrant). No new or unexpected safety issues arose; 90% of the patients and physicians rated fulvestrant tolerability as “very good” or “good”. In the largest prospective, fulvestrant-treated cohort to date, advanced breast cancer patients achieving SD or better after 3 months of treatment gained survival benefit by prolonging fulvestrant therapy—independent of disease and treatment history.
Literature
1.
go back to reference Milano A, Dal Lago L, Sotiriou C et al (2006) What clinicians need to know about antioestrogen resistance in breast cancer therapy. Eur J Cancer 42:2692–2705CrossRefPubMed Milano A, Dal Lago L, Sotiriou C et al (2006) What clinicians need to know about antioestrogen resistance in breast cancer therapy. Eur J Cancer 42:2692–2705CrossRefPubMed
2.
go back to reference Adamo V, Iorfida M, Montalto E et al (2007) Overview and new strategies in metastatic breast cancer (MBC) for treatment of tamoxifen-resistant patients. Ann Oncol 18:vi53–vi57CrossRefPubMed Adamo V, Iorfida M, Montalto E et al (2007) Overview and new strategies in metastatic breast cancer (MBC) for treatment of tamoxifen-resistant patients. Ann Oncol 18:vi53–vi57CrossRefPubMed
3.
go back to reference Kurokawa H, Arteaga CL (2003) ErbB (HER) receptors can abrogate antiestrogen action in human breast cancer by multiple signaling mechanism. Clin Cancer Res 9:511S–515SPubMed Kurokawa H, Arteaga CL (2003) ErbB (HER) receptors can abrogate antiestrogen action in human breast cancer by multiple signaling mechanism. Clin Cancer Res 9:511S–515SPubMed
5.
go back to reference Wakeling AE, Dukes M, Bowler J (1991) A potent specific pure antiestrogen with clinical potential. Cancer Res 51:3867–3873PubMed Wakeling AE, Dukes M, Bowler J (1991) A potent specific pure antiestrogen with clinical potential. Cancer Res 51:3867–3873PubMed
6.
go back to reference Wakeling AE (2000) Similarities and distinctions in the mode of action of different classes of antiestrogens. Endocr Relat Cancer 7:17–28CrossRefPubMed Wakeling AE (2000) Similarities and distinctions in the mode of action of different classes of antiestrogens. Endocr Relat Cancer 7:17–28CrossRefPubMed
7.
go back to reference Fawell SE, White R, Hoare S et al (1990) Inhibition of estrogen receptor-DNA binding by the ‘‘pure’’ antiestrogen ICI 164, 384 appears to be mediated by impaired receptor dimerization. Proc Natl Acad Sci USA 87:6883–6887CrossRefPubMed Fawell SE, White R, Hoare S et al (1990) Inhibition of estrogen receptor-DNA binding by the ‘‘pure’’ antiestrogen ICI 164, 384 appears to be mediated by impaired receptor dimerization. Proc Natl Acad Sci USA 87:6883–6887CrossRefPubMed
8.
go back to reference Dauvois S, White R, Parker MG (1993) The antiestrogen ICI 182780 disrupts estrogen receptor nucleocytoplasmic shuttling. J Cell Sci 106:1377–1388PubMed Dauvois S, White R, Parker MG (1993) The antiestrogen ICI 182780 disrupts estrogen receptor nucleocytoplasmic shuttling. J Cell Sci 106:1377–1388PubMed
9.
go back to reference Nicholson RI, Gee JM, Manning DL et al (1995) Responses to pure antiestrogens (ICI 164384, ICI 182780) in estrogen-sensitive and -resistant experimental and clinical breast cancer. Ann NY Acad Sci 761:148–163CrossRefPubMed Nicholson RI, Gee JM, Manning DL et al (1995) Responses to pure antiestrogens (ICI 164384, ICI 182780) in estrogen-sensitive and -resistant experimental and clinical breast cancer. Ann NY Acad Sci 761:148–163CrossRefPubMed
10.
go back to reference McClelland RA, Gee JM, Francis AB et al (1996) Short-term effects of pure anti-oestrogen ICI 182780 treatment on oestrogen receptor, epidermal growth factor receptor and transforming growth factor-alpha protein expression in human breast cancer. Eur J Cancer 32A:413–416CrossRefPubMed McClelland RA, Gee JM, Francis AB et al (1996) Short-term effects of pure anti-oestrogen ICI 182780 treatment on oestrogen receptor, epidermal growth factor receptor and transforming growth factor-alpha protein expression in human breast cancer. Eur J Cancer 32A:413–416CrossRefPubMed
11.
go back to reference Pietras RJ, Marquez DC, Chen HW et al (2003) Improved antitumor therapy with Herceptin and Faslodex for dual targeting of HER-2 and estrogen receptor signalling pathways in human breast cancers with overexpression of HER-2/neu gene. Breast Cancer Res Treat 82(Suppl. 1):S12 Pietras RJ, Marquez DC, Chen HW et al (2003) Improved antitumor therapy with Herceptin and Faslodex for dual targeting of HER-2 and estrogen receptor signalling pathways in human breast cancers with overexpression of HER-2/neu gene. Breast Cancer Res Treat 82(Suppl. 1):S12
12.
go back to reference Howell A, DeFriend DJ, Robertson JF et al (1996) Pharmacokinetics, pharmacological and anti-tumour effects of the specific anti-oestrogen ICI 182780 in women with advanced breast cancer. Br J Cancer 74:300–308PubMed Howell A, DeFriend DJ, Robertson JF et al (1996) Pharmacokinetics, pharmacological and anti-tumour effects of the specific anti-oestrogen ICI 182780 in women with advanced breast cancer. Br J Cancer 74:300–308PubMed
13.
go back to reference Osborne CK, Pippen J, Jones SE et al (2002) Double-blind, randomized trial comparing the efficacy and tolerability of fulvestrant versus anastrozole in postmenopausal women with advanced breast cancer progressing on prior endocrine therapy: results of a North American trial. J Clin Oncol 20:3386–3395CrossRefPubMed Osborne CK, Pippen J, Jones SE et al (2002) Double-blind, randomized trial comparing the efficacy and tolerability of fulvestrant versus anastrozole in postmenopausal women with advanced breast cancer progressing on prior endocrine therapy: results of a North American trial. J Clin Oncol 20:3386–3395CrossRefPubMed
14.
go back to reference Howell A, Robertson JF, Quaresma Albano J et al (2002) Fulvestrant, formerly ICI 182, 780, is as effective as anastrozole in postmenopausal women with advanced breast cancer progressing after prior endocrine treatment. J Clin Oncol 20:3396–3403CrossRefPubMed Howell A, Robertson JF, Quaresma Albano J et al (2002) Fulvestrant, formerly ICI 182, 780, is as effective as anastrozole in postmenopausal women with advanced breast cancer progressing after prior endocrine treatment. J Clin Oncol 20:3396–3403CrossRefPubMed
15.
go back to reference Robertson JF, Osborne CK, Howell A et al (2003) Fulvestrant versus anastrozole for the treatment of advanced breast carcinoma in postmenopausal women: a prospective combined analysis of two multicenter trials. Cancer 98:229–238CrossRefPubMed Robertson JF, Osborne CK, Howell A et al (2003) Fulvestrant versus anastrozole for the treatment of advanced breast carcinoma in postmenopausal women: a prospective combined analysis of two multicenter trials. Cancer 98:229–238CrossRefPubMed
16.
go back to reference Chia S, Gradishar W, Mauriac L et al (2008) Double-blind, randomized placebo controlled trial of fulvestrant compared with exemestane after prior nonsteroidal aromatase inhibitor therapy in postmenopausal women with hormone receptor-positive, advanced breast cancer: results from EFECT. J Clin Oncol 26:1664–1670CrossRefPubMed Chia S, Gradishar W, Mauriac L et al (2008) Double-blind, randomized placebo controlled trial of fulvestrant compared with exemestane after prior nonsteroidal aromatase inhibitor therapy in postmenopausal women with hormone receptor-positive, advanced breast cancer: results from EFECT. J Clin Oncol 26:1664–1670CrossRefPubMed
17.
go back to reference Howell A, Robertson JF, Abram P et al (2004) Comparison of fulvestrant versus tamoxifen for the treatment of advanced breast cancer in postmenopausal women previously untreated with endocrine therapy: a multinational, double-blind, randomized trial. J Clin Oncol 22:1605–1613CrossRefPubMed Howell A, Robertson JF, Abram P et al (2004) Comparison of fulvestrant versus tamoxifen for the treatment of advanced breast cancer in postmenopausal women previously untreated with endocrine therapy: a multinational, double-blind, randomized trial. J Clin Oncol 22:1605–1613CrossRefPubMed
18.
go back to reference Hu XF, Veroni M, De Luise M et al (1993) Circumvention of tamoxifen resistance by the pure anti-estrogen ICI 182, 780. Int J Cancer 55:873–876CrossRefPubMed Hu XF, Veroni M, De Luise M et al (1993) Circumvention of tamoxifen resistance by the pure anti-estrogen ICI 182, 780. Int J Cancer 55:873–876CrossRefPubMed
19.
go back to reference Freddie CT, Christensen GL, Lykkesfeldt AE (2004) A new MCF-7 breast cancer cell line resistant to the arzoxifene metabolite desmethylarzoxifene. Mol Cell Endocrinol 220:97–107CrossRefPubMed Freddie CT, Christensen GL, Lykkesfeldt AE (2004) A new MCF-7 breast cancer cell line resistant to the arzoxifene metabolite desmethylarzoxifene. Mol Cell Endocrinol 220:97–107CrossRefPubMed
20.
go back to reference Bartsch R, Wenzel C, Altorjai G et al (2007) Her2 and progesterone receptor status are not predictive of response to fulvestrant treatment. Clin Cancer Res 13:4435–4439CrossRefPubMed Bartsch R, Wenzel C, Altorjai G et al (2007) Her2 and progesterone receptor status are not predictive of response to fulvestrant treatment. Clin Cancer Res 13:4435–4439CrossRefPubMed
21.
go back to reference Robertson JF, A. Agrawal A, Gutteridge E et al (2006) Correlation of CA15.3 levels with clinical response in advanced breast cancer (ABC) patients receiving fulvestrant. J Clin Oncol 24:18S (abstr 641) Robertson JF, A. Agrawal A, Gutteridge E et al (2006) Correlation of CA15.3 levels with clinical response in advanced breast cancer (ABC) patients receiving fulvestrant. J Clin Oncol 24:18S (abstr 641)
22.
go back to reference Dodwell D, Pippen J (2006) Time to response: comparison of fulvestrant and oral endocrine agents. Clin Breast Cancer 7:244–247CrossRefPubMed Dodwell D, Pippen J (2006) Time to response: comparison of fulvestrant and oral endocrine agents. Clin Breast Cancer 7:244–247CrossRefPubMed
23.
go back to reference Mauriac L, Pippen JE, Quaresma Albano J et al (2003) Fulvestrant (Faslodex) versus anastrozole for the second-line treatment of advanced breast cancer in subgroups of postmenopausal women with visceral and non-visceral metastases: combined results from two multicentre trials. Eur J Cancer 39:1228–1233CrossRefPubMed Mauriac L, Pippen JE, Quaresma Albano J et al (2003) Fulvestrant (Faslodex) versus anastrozole for the second-line treatment of advanced breast cancer in subgroups of postmenopausal women with visceral and non-visceral metastases: combined results from two multicentre trials. Eur J Cancer 39:1228–1233CrossRefPubMed
24.
go back to reference Bartsch R, Mlineritsch B, Gnant M et al (2009) The Austrian fulvestrant registry: results from a prospective observation of fulvestrant in postmenopausal patients with metastatic breast cancer. Breast Cancer Res Treat 115:373–380CrossRefPubMed Bartsch R, Mlineritsch B, Gnant M et al (2009) The Austrian fulvestrant registry: results from a prospective observation of fulvestrant in postmenopausal patients with metastatic breast cancer. Breast Cancer Res Treat 115:373–380CrossRefPubMed
25.
go back to reference Mlineritsch B, Psenak O, Mayer P et al (2007) Fulvestrant (‘Faslodex’) in heavily pretreated postmenopausal patients with advanced breast cancer: single centre clinical experience from the compassionate use programme. Breast Cancer Res Treat 106:105–112CrossRefPubMed Mlineritsch B, Psenak O, Mayer P et al (2007) Fulvestrant (‘Faslodex’) in heavily pretreated postmenopausal patients with advanced breast cancer: single centre clinical experience from the compassionate use programme. Breast Cancer Res Treat 106:105–112CrossRefPubMed
26.
go back to reference Mauriac L, Romieu G, Bines J (2009) Activity of fulvestrant versus exemestane in advanced breast cancer patients with or without visceral metastases: data from the EFECT trial. Breast Cancer Res Treat 117:69–75CrossRefPubMed Mauriac L, Romieu G, Bines J (2009) Activity of fulvestrant versus exemestane in advanced breast cancer patients with or without visceral metastases: data from the EFECT trial. Breast Cancer Res Treat 117:69–75CrossRefPubMed
27.
go back to reference Chia S, Gradishar W (2008) Fulvestrant: expanding the endocrine treatment options for patients with hormone receptor-positive advanced breast cancer. Breast 17:S16–S21CrossRefPubMed Chia S, Gradishar W (2008) Fulvestrant: expanding the endocrine treatment options for patients with hormone receptor-positive advanced breast cancer. Breast 17:S16–S21CrossRefPubMed
28.
go back to reference Sorlie T, Tibshirani R, Parker J et al (2003) Repeated observation of breast tumor subtypes in independent gene expression data sets. Proc Natl Acad Sci USA 100(14):8418–8423CrossRefPubMed Sorlie T, Tibshirani R, Parker J et al (2003) Repeated observation of breast tumor subtypes in independent gene expression data sets. Proc Natl Acad Sci USA 100(14):8418–8423CrossRefPubMed
29.
go back to reference Lux MP, Hartmann M, Jackisch C et al (2009) Cost-utility analysis for advanced breast cancer therapy in Germany: results of the fulvestrant sequencing model. Breast Cancer Res Treat 117:305–317CrossRefPubMed Lux MP, Hartmann M, Jackisch C et al (2009) Cost-utility analysis for advanced breast cancer therapy in Germany: results of the fulvestrant sequencing model. Breast Cancer Res Treat 117:305–317CrossRefPubMed
30.
go back to reference Freedman O, Amir E, Dranitsaris G et al (2009) Predicting benefit from fulvestrant in pretreated metastatic breast cancer patients. Breast Cancer Res Treat 118:377–383CrossRefPubMed Freedman O, Amir E, Dranitsaris G et al (2009) Predicting benefit from fulvestrant in pretreated metastatic breast cancer patients. Breast Cancer Res Treat 118:377–383CrossRefPubMed
32.
go back to reference Robertson JF, Llombart-Cussac A, Rolski J et al (2009) Activity of fulvestrant 500 mg versus anastrozole 1 mg as first-line treatment for advanced breast cancer: results from the FIRST study. J Clin Oncol 27:4530–4535CrossRefPubMed Robertson JF, Llombart-Cussac A, Rolski J et al (2009) Activity of fulvestrant 500 mg versus anastrozole 1 mg as first-line treatment for advanced breast cancer: results from the FIRST study. J Clin Oncol 27:4530–4535CrossRefPubMed
33.
go back to reference Di Leo A, Jerusalem G, Petruzelka L et al (2010) Results of the CONFIRM phase iii trial comparing fulvestrant 250 mg with fulvestrant 500 mg in postmenopausal women with estrogen receptor-positive advanced breast cancer. J Clin Oncol. doi:10.1200/JCO.2010.28.8415 Di Leo A, Jerusalem G, Petruzelka L et al (2010) Results of the CONFIRM phase iii trial comparing fulvestrant 250 mg with fulvestrant 500 mg in postmenopausal women with estrogen receptor-positive advanced breast cancer. J Clin Oncol. doi:10.​1200/​JCO.​2010.​28.​8415
Metadata
Title
Benefits of early and prolonged fulvestrant treatment in 848 postmenopausal advanced breast cancer patients
Authors
Mathias Warm
Ronald Kates
Friedrich Overkamp
Anke Thomas
Nadia Harbeck
Publication date
01-01-2011
Publisher
Springer US
Published in
Breast Cancer Research and Treatment / Issue 1/2011
Print ISSN: 0167-6806
Electronic ISSN: 1573-7217
DOI
https://doi.org/10.1007/s10549-010-1214-3

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