An evaluation of fulvestrant for the treatment of metastatic breast cancer

Mohsin Soleja, Ganesh V. Raj, Nisha Unni

Research output: Contribution to journalArticle

Abstract

Introduction: Fulvestrant is currently the only selective estrogen receptor degrader (SERD) that is approved for clinical use in estrogen receptor (ER) positive advanced breast cancer (ABC). The drug is approved as single-agent therapy in the first and second-line setting of metastatic ER-positive breast cancer. Areas covered: In this review, the authors review the preclinical studies that were pivotal in the development of fulvestrant, the pharmacologic properties of the drug, and the key clinical trials that resulted in its approval for clinical use. The authors discuss mechanisms of endocrine resistance and potential targets for endocrine refractory disease while highlighting ongoing studies that assess fulvestrant use with novel agents. Expert opinion: While fulvestrant has limited use in the first-line setting in advanced breast cancer, it is most frequently used in the second line after progression with aromatase inhibitors. The combination of fulvestrant with CDK4/6 inhibitors has shown a clear benefit over monotherapy in patients who progress on prior endocrine therapy. Further study is necessary to assess if patient outcomes can be enhanced by optimizing the sequence of endocrine therapies, targeting resistance pathways with novel agents, and development of new agents in the SERD class.

Original languageEnglish (US)
Pages (from-to)1819-1829
Number of pages11
JournalExpert Opinion on Pharmacotherapy
Volume20
Issue number15
DOIs
StatePublished - Oct 13 2019

Fingerprint

Estrogen Receptors
Breast Neoplasms
Endocrine System Diseases
Therapeutics
Aromatase Inhibitors
Expert Testimony
Pharmaceutical Preparations
fulvestrant
Clinical Trials

Keywords

  • advanced breast cancer
  • endocrine resistance
  • Fulvestrant
  • hormone-receptor positive
  • metastatic breast cancer
  • Selective Estrogen Receptor Positive (SERD)

ASJC Scopus subject areas

  • Pharmacology
  • Pharmacology (medical)

Cite this

An evaluation of fulvestrant for the treatment of metastatic breast cancer. / Soleja, Mohsin; Raj, Ganesh V.; Unni, Nisha.

In: Expert Opinion on Pharmacotherapy, Vol. 20, No. 15, 13.10.2019, p. 1819-1829.

Research output: Contribution to journalArticle

@article{80a776fd5e784211a1b2470659908d32,
title = "An evaluation of fulvestrant for the treatment of metastatic breast cancer",
abstract = "Introduction: Fulvestrant is currently the only selective estrogen receptor degrader (SERD) that is approved for clinical use in estrogen receptor (ER) positive advanced breast cancer (ABC). The drug is approved as single-agent therapy in the first and second-line setting of metastatic ER-positive breast cancer. Areas covered: In this review, the authors review the preclinical studies that were pivotal in the development of fulvestrant, the pharmacologic properties of the drug, and the key clinical trials that resulted in its approval for clinical use. The authors discuss mechanisms of endocrine resistance and potential targets for endocrine refractory disease while highlighting ongoing studies that assess fulvestrant use with novel agents. Expert opinion: While fulvestrant has limited use in the first-line setting in advanced breast cancer, it is most frequently used in the second line after progression with aromatase inhibitors. The combination of fulvestrant with CDK4/6 inhibitors has shown a clear benefit over monotherapy in patients who progress on prior endocrine therapy. Further study is necessary to assess if patient outcomes can be enhanced by optimizing the sequence of endocrine therapies, targeting resistance pathways with novel agents, and development of new agents in the SERD class.",
keywords = "advanced breast cancer, endocrine resistance, Fulvestrant, hormone-receptor positive, metastatic breast cancer, Selective Estrogen Receptor Positive (SERD)",
author = "Mohsin Soleja and Raj, {Ganesh V.} and Nisha Unni",
year = "2019",
month = "10",
day = "13",
doi = "10.1080/14656566.2019.1651293",
language = "English (US)",
volume = "20",
pages = "1819--1829",
journal = "Expert Opinion on Pharmacotherapy",
issn = "1465-6566",
publisher = "Informa Healthcare",
number = "15",

}

TY - JOUR

T1 - An evaluation of fulvestrant for the treatment of metastatic breast cancer

AU - Soleja, Mohsin

AU - Raj, Ganesh V.

AU - Unni, Nisha

PY - 2019/10/13

Y1 - 2019/10/13

N2 - Introduction: Fulvestrant is currently the only selective estrogen receptor degrader (SERD) that is approved for clinical use in estrogen receptor (ER) positive advanced breast cancer (ABC). The drug is approved as single-agent therapy in the first and second-line setting of metastatic ER-positive breast cancer. Areas covered: In this review, the authors review the preclinical studies that were pivotal in the development of fulvestrant, the pharmacologic properties of the drug, and the key clinical trials that resulted in its approval for clinical use. The authors discuss mechanisms of endocrine resistance and potential targets for endocrine refractory disease while highlighting ongoing studies that assess fulvestrant use with novel agents. Expert opinion: While fulvestrant has limited use in the first-line setting in advanced breast cancer, it is most frequently used in the second line after progression with aromatase inhibitors. The combination of fulvestrant with CDK4/6 inhibitors has shown a clear benefit over monotherapy in patients who progress on prior endocrine therapy. Further study is necessary to assess if patient outcomes can be enhanced by optimizing the sequence of endocrine therapies, targeting resistance pathways with novel agents, and development of new agents in the SERD class.

AB - Introduction: Fulvestrant is currently the only selective estrogen receptor degrader (SERD) that is approved for clinical use in estrogen receptor (ER) positive advanced breast cancer (ABC). The drug is approved as single-agent therapy in the first and second-line setting of metastatic ER-positive breast cancer. Areas covered: In this review, the authors review the preclinical studies that were pivotal in the development of fulvestrant, the pharmacologic properties of the drug, and the key clinical trials that resulted in its approval for clinical use. The authors discuss mechanisms of endocrine resistance and potential targets for endocrine refractory disease while highlighting ongoing studies that assess fulvestrant use with novel agents. Expert opinion: While fulvestrant has limited use in the first-line setting in advanced breast cancer, it is most frequently used in the second line after progression with aromatase inhibitors. The combination of fulvestrant with CDK4/6 inhibitors has shown a clear benefit over monotherapy in patients who progress on prior endocrine therapy. Further study is necessary to assess if patient outcomes can be enhanced by optimizing the sequence of endocrine therapies, targeting resistance pathways with novel agents, and development of new agents in the SERD class.

KW - advanced breast cancer

KW - endocrine resistance

KW - Fulvestrant

KW - hormone-receptor positive

KW - metastatic breast cancer

KW - Selective Estrogen Receptor Positive (SERD)

UR - http://www.scopus.com/inward/record.url?scp=85072717432&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85072717432&partnerID=8YFLogxK

U2 - 10.1080/14656566.2019.1651293

DO - 10.1080/14656566.2019.1651293

M3 - Article

C2 - 31486688

AN - SCOPUS:85072717432

VL - 20

SP - 1819

EP - 1829

JO - Expert Opinion on Pharmacotherapy

JF - Expert Opinion on Pharmacotherapy

SN - 1465-6566

IS - 15

ER -