Fulvestrant in hormone-positive advanced breast cancer: Real-world outcome

• Main Authors: Indhuja Muthiah Vaikundaraja, Manikandan Dhanushkodi, Venkatraman Radhakrishnan, Jayachandran Perumal Kalaiarasi, Nikita Mehra, Arun Kumar Rajan, Gangothri Selvarajan, Siva Sree Kesana, Balasubramanian Ananthi, Priya Iyer, Geetha Senguttuvan, Manjula Rao, Arvind Krishnamurthy, Sridevi Velusamy, Hemanth Raj, Rama Ranganathan, Shirley Sundersingh, Selvaluxmy Ganesarajah, Trivadi S Ganesan, Tenali Gnana Sagar
• Format: Article
• Language: English
• Published: Wolters Kluwer Medknow Publications 2020-01-01
• Series: Cancer Research, Statistics, and Treatment
• Subjects: advanced breast cancer; fulvestrant; hormone positive
• Online Access: http://www.crstonline.com/article.asp?issn=2590-3233;year=2020;volume=3;issue=2;spage=275;epage=280;aulast=Vaikundaraja
• ISSN: 2590-3233; 2590-3225

Background: Fulvestrant has been shown to improve survival in hormone-positive, HER2-negative advanced breast cancer (ABC). There is no study on fulvestrant from India. Objectives: This study was done to assess the prognostic factors and outcome of patients with ABC treated with fulvestrant. Materials and Methods: This was a retrospective study from the case records of patients who received fulvestrant for hormone receptor (HR)-positive breast cancer from May 2011 to July 2019. Results: A total of 37 women were included in this analysis, with a median follow-up of 9 months. The median age was 63 years. The Eastern Cooperative Oncology Group performance status (ECOG PS) was 0–2 (78%) and 3–4 (22%). The sites of metastasis were bone (59%), lung (43%), liver (32%), lymph node (24%), and bone only (20%). Patients with visceral metastasis and visceral crisis constituted 60% and 13%, respectively. The median number of lines of prior systemic therapy for metastatic disease was 2 (range, 0–6). The dose of fulvestrant used was 500 mg in 76% and 250 mg in 24%. There were no Grade 3 or 4 toxicities due to fulvestrant. The median progression-free survival and overall survival were 10 months (95% confidence interval [CI], 4–15.9 months) and 21 months (95% CI, 8.9–33.1 months), respectively. Univariate analysis showed that patients with ECOG PS 3–4 had a worse survival as compared to patients with PS 0–2. Conclusion: This is the first study on the outcomes of fulvestrant in advanced breast cancer from India. Fulvestrant is safe, well-tolerated, and effective in patients with hormone-positive ABC. Fulvestrant can be recommended even in heavily pretreated HR-positive advanced breast cancer and in those with a poor general condition (ECOG PS 3 or 4) who are ineligible for chemotherapy.