Fulvestrant versus anastrozole for the treatment of advanced breast carcinoma in postmenopausal women: A prospective combined analysis of two multicenter trials

• Published in: Cancer Vol. 98; no. 2; pp. 229 - 238
• Main Authors: ROBERTSON, John F. R, OSBORNE, C. Kent, BUZDAR, Aman, WEBSTER, Alan, MORRIS, Charles, HOWELL, Anthony, JONES, Stephen E, MAURIAC, Louis, ELLIS, Matthew, KLEEBERG, Ulrich R, COME, Steven E, VERGOTE, Ignace, GERTLER, Stan
• Format: Journal Article
• Language: English
• Published: New York, NY Wiley-Liss 15-07-2003
• Subjects: Adult; Aged; Aged, 80 and over; Antineoplastic agents; Antineoplastic Agents, Hormonal - administration & dosage; Antineoplastic Agents, Hormonal - therapeutic use; Biological and medical sciences; Breast Neoplasms - drug therapy; Breast Neoplasms - secondary; Chemotherapy; Disease Progression; Double-Blind Method; Estradiol - administration & dosage; Estradiol - analogs & derivatives; Estradiol - therapeutic use; Estrogen Antagonists - administration & dosage; Estrogen Antagonists - therapeutic use; Estrogen Receptor Modulators - administration & dosage; Estrogen Receptor Modulators - therapeutic use; Female; Humans; Medical sciences; Middle Aged; Nitriles - administration & dosage; Nitriles - therapeutic use; Pharmacology. Drug treatments; Postmenopause; Prospective Studies; Treatment Outcome; Triazoles - administration & dosage; Triazoles - therapeutic use; Antineoplastic agent; Phase III trial; duration of response; Carcinoma; Multicenter study; Antiestrogen; Antihormone; Estrogen synthase; Intramuscular administration; Fulvestrant; Prospective; Postmenopause; Advanced stage; Mammary gland; Non steroid compound; Human; Enzyme; Anastrozole; Oral administration; Enzyme inhibitor; combined analysis; Malignant tumor; Mammary gland diseases; Chemotherapy; Treatment; Triazole derivatives; estrogen receptor antagonist; Comparative study
• ISSN: 0008-543X; 1097-0142
• DOI: 10.1002/cncr.11468

Fulvestrant (ICI 182,780) is a new type of estrogen receptor (ER) antagonist that down-regulates the ER and has no known agonist effects. The authors report the prospectively planned combined analysis of data from 2 Phase III trials comparing fulvestrant 250 mg monthly (n=428) and anastrozole 1 mg daily (n=423) in postmenopausal women with advanced breast carcinoma (ABC) who previously had progressed after receiving endocrine treatment.
The primary endpoint was time to progression (TTP). Secondary endpoints included objective response (OR), duration of response (DOR), and tolerability. The trials were designed to demonstrate superiority of fulvestrant over anastrozole. Noninferiority of fulvestrant versus anastrozole was determined using a retrospectively applied statistical test.
At a median follow-up of 15.1 months, approximately 83% of patients in each treatment arm had progressed. The median TTP was 5.5 months in the fulvestrant group and 4.1 months in the anastrozole group, and the OR rates were 19.2% and 16.5% for fulvestrant and anastrozole, respectively (although the difference between treatments was not statistically significant). In patients who responded, further follow-up (median, 22.1 months) was performed to obtain more complete information on DOR; the median DOR (from randomization to disease progression) in patients who responded to treatment was 16.7 months in the fulvestrant group and 13.7 months in the anastrozole group. In a statistical analysis of DOR (using all randomized patients; from the start of response to disease progression), DOR was significantly longer for patients in the fulvestrant group compared with patients in the anastrozole group. Both drugs were tolerated well; withdrawals due to drug-related adverse events were 0.9% and 1.2% in the fulvestrant group and the anastrozole group, respectively. The incidence of joint disorders was significantly lower in the fulvestrant group (P=0.0036).
Fulvestrant was tolerated well and was at least as effective as anastrozole in the second-line treatment of patients with ABC. This new hormonaltherapy may provide a valuable treatment option for ABC in postmenopausal women.