Anastrozole plus fulvestrant is associated with longer progression-free survival than anastrozole alone when used by women with metastatic hormone receptor-positive breast cancer (New England Journal of Medicine 2012;367:435).
Researchers randomised 707 women, who had not previously received treatment for their metastatic breast cancer, to receive anastrozole alone or anastrozole plus fulvestrant (500mg loading dose, then 250mg on days 14 and 28, and monthly thereafter).
Average progression-free survival, the primary outcome, was 15 months for patients receiving the combination treatment compared with 13.5 months for those receiving monotherapy (hazard ratio for progression or death 0.80, 95% confidence interval 0.68?0.94; P=0.007).
Rates of toxicity were similar between the two groups.
?These findings are interesting, and a breakthrough for patients with previously untreated metastatic breast cancer,? said Kingsley Wildman, Macmillan pharmacist at Sussex Cancer Network. He pointed out that the most profound gains in progression-free survival appear to be in the subgroup of patients who had not been treated with tamoxifen in the past.
?One drawback,? he told Clinical Pharmacist, ?is the 250mg dose of fulvestrant in this trial, which raises questions about how the current UK-licensed dose of 500mg could be used in this setting.?
Mr Wildman went on: ?For fulvestrant to be used in light of this new evidence, I?would expect that the funding would come from an area?s cancer drugs fund.?
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