Fulvestrant, Formerly ICI 182,780, Is as Effective as Anastrozole in Postmenopausal Women With Advanced Breast Cancer Progressing After Prior Endocrine Treatment

Howell, Anthony; Robertson, J. F. R.; Albano, J.; Aschermannová, A.; Mauriac, L.; Kleeberg, Ulrich R.; Vergote, Ignace; Erikstein, Bjørn; Webster, Alan; Morris, Caroline

doi:10.1200/jco.2002.10.057

Cited by 616 publications

(356 citation statements)

References 16 publications

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“…1993, Lykkesfeldt et al . 1994, 1995); further, fulvestrant was comparable to aromatase inhibitors in clinical efficacy in postmenopausal women having progressed on tamoxifen therapy (Howell et al . 2002, Osborne et al .…”

Section: Serms Vs Serds: Two Separate Classes Of Antiestrogens?mentioning

confidence: 99%

Antiestrogens: structure-activity relationships and use in breast cancer treatment

Traboulsi

Ezzy

Gleason

et al. 2017

Journal of Molecular Endocrinology

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About 70% of breast tumors express estrogen receptor alpha (ERα), which mediates the proliferative effects of estrogens on breast epithelial cells, and are candidates for treatment with antiestrogens, steroidal or non-steroidal molecules designed to compete with estrogens and antagonize ERs. The variable patterns of activity of antiestrogens (AEs) in estrogen target tissues and the lack of systematic cross-resistance between different types of molecules have provided evidence for different mechanisms of action. AEs are typically classified as selective estrogen receptor modulators (SERMs), which display tissue-specific partial agonist activity (e.g. tamoxifen and raloxifene), or as pure AEs (e.g. fulvestrant), which enhance ERα post-translational modification by ubiquitin-like molecules and accelerate its proteasomal degradation. Characterization of second- and third-generation AEs, however, suggests the induction of diverse ERα structural conformations, resulting in variable degrees of receptor downregulation and different patterns of systemic properties in animal models and in the clinic.

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Section: Serms Vs Serds: Two Separate Classes Of Antiestrogens?mentioning

confidence: 99%

Antiestrogens: structure-activity relationships and use in breast cancer treatment

Traboulsi

Ezzy

Gleason

et al. 2017

Journal of Molecular Endocrinology

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“…Data from preclinical model systems investigating initially endocrine sensitive BC cells subjected to long term anti-estrogen therapy has revealed that there are several stages of acquired resistance with an over-time shift in ER as well as growth factor expression [12]. Patients with acquired resistance might benefit from other types of endocrine intervention as estrogen withdrawal or therapy with the pure antiestrogen fulvestrant [13][14], contrary to patients likely to develop intrinsic resistance, for which endocrine therapy alone should be avoided. Our aim was to investigate intratumoral levels of VEGFR2 and downstream activated p38 MAPK (referred to as p38) in relation to previously determined intratumoral VEGF levels, routine breast cancer factors, localization of relapses and survival in receptor positive patients subjected to adjuvant endocrine treatment.…”

Section: Introductionmentioning

confidence: 99%

Vascular endothelial growth factor receptor 2 and downstream p38 mitogen-activated protein kinase are possible candidate markers of intrinsic resistance to adjuvant endocrine treatment in steroid receptor positive breast cancer

Linderholm¹,

Hellborg²,

Johansson³

et al. 2010

Breast Cancer Res Treat

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“…Subsequent trials investigated the use of fulvestrant in second-line therapy. Two trials reported an effectiveness equivalent to that of anastrozole [21]. In the context of the randomized phase-III EFECT trial, the effectiveness of fulvestrant in metastatic breast cancer patients who had been pre-treated with nonsteroidal AI's was compared to that of exemestane [15].…”

Section: Discussionmentioning

confidence: 99%

Cost-utility analysis for advanced breast cancer therapy in Germany: results of the fulvestrant sequencing model

Lux

Hartmann

Jackisch

et al. 2009

Breast Cancer Res Treat

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Therapy decisions in advanced breast cancer (ABC) increasingly require assessment not only of treatment efficacy but also of cost-effectiveness. To this end, we performed a cost-utility analysis by comparing treatment sequences including/omitting fulvestrant in a hypothetical population of hormone receptor-positive (HR?) postmenopausal women with ABC. The analysis was performed from the German health care perspective. Using a first-order sequential Markov model, expected costs and utilities were calculated over a time horizon of 10 years for cohorts of patients with HR? ABC, previously treated for at least 5 years using adjuvant endocrine therapies. Utilities were primarily quantified in terms of quality adjusted life years (QALY). ''Base-case'' estimates of state transition rates, resource utilization, and other model parameters were derived from published evidence and expert assessment. The impacts of uncertainties in all key model parameters were evaluated by sensitivity analysis. Costs and benefits were discounted at 3% annually. Including second-line fulvestrant in the treatment sequence led to greater estimated health gains (0.021 QALY) and cost savings of €564 ($745, £380) per patient, i.e. the fulvestrant-containing sequence was ''dominant''. The prediction of a cost savings was robust with respect to variations in all key parameters. The probability of acceptable cost-effectiveness for the fulvestrant sequence was 72% at a willingness to pay (WTP) of €30,000/QALY ($39,621/QALY, £20,198/QALY); the probability was even higher at lower WTP and substantially exceeded 50% for any realistic WTP. In a representative population of women with HR? advanced breast cancer, inclusion of fulvestrant in the treatment sequence provides a cost-effective alternative from the German health care perspective. A high probability of cost-effectiveness is maintained under variations in all key parameters. The results reflect a tendency for patients receiving fulvestrant at an early stage to maintain high quality of life for a longer interval.Electronic supplementary material The online version of this article

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Fulvestrant, Formerly ICI 182,780, Is as Effective as Anastrozole in Postmenopausal Women With Advanced Breast Cancer Progressing After Prior Endocrine Treatment

Abstract: Fulvestrant was as effective as anastrozole. These data confirm that fulvestrant is an additional, effective, and well-tolerated treatment for advanced breast cancer in postmenopausal women whose disease progressed on prior endocrine therapy.

Cited by 616 publications

References 16 publications

Antiestrogens: structure-activity relationships and use in breast cancer treatment

Antiestrogens: structure-activity relationships and use in breast cancer treatment

Vascular endothelial growth factor receptor 2 and downstream p38 mitogen-activated protein kinase are possible candidate markers of intrinsic resistance to adjuvant endocrine treatment in steroid receptor positive breast cancer

Cost-utility analysis for advanced breast cancer therapy in Germany: results of the fulvestrant sequencing model

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