Clinical benefit of fulvestrant monotherapy in the multimodal treatment of hormone receptor and HER2 positive advanced breast cancer: a case series

Rusz, Orsolya; Kószó, Renáta; Dobi, Ágnes; Csenki, Melinda; Valicsek, Erzsébet; Nikolényi, Alíz; Uhercsák, Gabriella; Cserháti, Adrienn; Kahán, Zsuzsanna

doi:10.2147/ott.s170736

Cited by 17 publications

(13 citation statements)

References 22 publications

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“…Treatment for patients with HER2 -BM For the treatment of patients with ER + /HER2 -BCBM, some responses have been observed with tamoxifen, 85 aromatase inhibitors 86,87 and fulvestrant 88 , and therefore, in the absence of therapeutic alternatives, these low-toxicity treatments have a place in paucisymptomatic ER + patients.…”

Section: Trastuzumab-based Regimens For Patients With Her2 + Bmmentioning

confidence: 99%

Treatment strategies for breast cancer brain metastases

2020

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Brain metastases from breast cancer (BCBM) constitute the second most common cause of brain metastasis (BM), and the incidence of these frequently lethal lesions is currently increasing, following better systemic treatment. Patients with ER-negative and HER2positive metastatic breast cancer (BC) are the most likely to develop BM, but if this diagnosis remains associated with a worse prognosis, long survival is now common for patients with HER2-positive BC. BCBM represents a therapeutic challenge that needs a coordinated treatment strategy along international guidelines. Surgery has always to be considered when feasible. It is now well established that stereotaxic radiosurgery allows for equivalent control and less-cognitive toxicities than whole-brain radiation therapy, which should be delayed as much as possible. Medical treatment for BCBM is currently a rapidly evolving field. It has been shown that the blood-brain barrier (BBB) is often impaired in macroscopic BM, and several chemotherapy regimens, antibody-drug conjugates and tyrosine-kinase inhibitors have been shown to be active on BCBM and can be part of the global treatment strategy. This paper provides an overview of the therapeutic option for BCBM that is currently available and outlines potential new approaches for tackling these deadly secondary tumours.

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Section: Trastuzumab-based Regimens For Patients With Her2 + Bmmentioning

confidence: 99%

Treatment strategies for breast cancer brain metastases

2020

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“…CNS metastases occur less frequently for luminal-types compared with other subtypes [ 1 , 21 ]. Only case reports of successful cases have been reported regarding the effects of endocrine therapy (tamoxifen, megesterol acetate, letrozole, fulvestrant) on BM for ER-positive and HER2-negative breast cancer, and efficacy has not been confirmed in clinical trials [ 110 ].…”

Section: Systemic Therapy For Bcbmmentioning

confidence: 99%

Breast Cancer Brain Metastasis—Overview of Disease State, Treatment Options and Future Perspectives

Watase

Shiino

Shimoi³

et al. 2021

Cancers

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Breast cancer is the second most common origin of brain metastasis after lung cancer. Brain metastasis in breast cancer is commonly found in patients with advanced course disease and has a poor prognosis because the blood–brain barrier is thought to be a major obstacle to the delivery of many drugs in the central nervous system. Therefore, local treatments including surgery, stereotactic radiation therapy, and whole-brain radiation therapy are currently considered the gold standard treatments. Meanwhile, new targeted therapies based on subtype have recently been developed. Some drugs can exceed the blood–brain barrier and enter the central nervous system. New technology for early detection and personalized medicine for metastasis are warranted. In this review, we summarize the historical overview of treatment with a focus on local treatment, the latest drug treatment strategies, and future perspectives using novel therapeutic agents for breast cancer patients with brain metastasis, including ongoing clinical trials.

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“…Fulvestrant has been found to be as effective as the third-generation aromatase inhibitors (AIs) anastrozole and letrozole for advanced, post-menopausal, tamoxifen-resistant breast cancer, and also appears to be effective after treatment with non-steroidal AIs. [ 19 ] Based on the evidence available, for the patient we presented here, concomitant fulvestrant with irradiation was prescribed under our MDT. Throughout radiation treatment, patients were examined weekly by the radiation oncologist for acute toxicities using the Radiation Therapy Oncology Group (RTOG) radiation morbidity scoring criteria.…”

Section: Discussionmentioning

confidence: 99%

Concomitant fulvestrant with reirradiation for unresectable locoregional recurrent estrogen receptor positive (ER+) breast cancer

et al. 2020

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Rationale: Locoregional recurrence of breast cancer is a challenging issue for clinicians. Treatment options for unresectable recurrent estrogen receptor positive (ER+) breast cancer in previously irradiated area are limited. Some studies showed concomitant fulvestrant with radiation therapy might increase radiosensitivity compared with radiation alone in vitro, no in vivo reports yet. Patient concern: Here, we present a case report and make a narrative review of concomitant fulvestrant with radiation therapy for unresectable locoregional recurrent ER+ breast cancer. The patient was treated with modified radical mastectomy in 2015, adjuvant chemotherapy, radiotherapy, followed by exemestane until November 2018, relapsed in internal mammary lymph nodes with sternum involved. Diagnosis: The final diagnosis was breast cancer internal mammary lymph nodes metastasis with sternum involved. Interventions: After diagnosis was made, concurrent fulvestrant with reirradiation as a palliative treatment were proposed under multiple disciplinary team. Outcomes: There was a good clinical response, enabling curative chance with radiation therapy to a total dose of 60 Gy. Computed tomography scan revealed no evidence of residual tumor. Lessons: As far as we know, this is the first report concerning concomitant fulvestrant with reirradiation for unresectable locoregional recurrent ER+ breast cancer. Since no severe adverse events were observed, this strategy could be a suitable “loco-regional rescue therapy” to further reduce tumor progression or even reach a curative effect. Studies of this treatment strategy in randomized clinical trials are warranted to further assess its safety and effectiveness.

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Clinical benefit of fulvestrant monotherapy in the multimodal treatment of hormone receptor and HER2 positive advanced breast cancer: a case series

Cited by 17 publications

References 22 publications

Treatment strategies for breast cancer brain metastases

Treatment strategies for breast cancer brain metastases

Breast Cancer Brain Metastasis—Overview of Disease State, Treatment Options and Future Perspectives

Concomitant fulvestrant with reirradiation for unresectable locoregional recurrent estrogen receptor positive (ER+) breast cancer

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