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Blancas I, Fontanillas M, Conde V, Lao J, Martínez E, Sotelo MJ, Jaen A, Bayo JL, Carabantes F, Illarramendi JJ, Gordon MM, Cruz J, García-Palomo A, Mendiola C, Pérez-Ruiz E, Bofill JS, Baena-Cañada JM, Jáñez NM, Esquerdo G, Ruiz-Borrego M. Efficacy of fulvestrant in the treatment of postmenopausal women with endocrine-resistant advanced breast cancer in routine clinical practice. Clin Transl Oncol 2017; 20:862-869. [PMID: 29178019 DOI: 10.1007/s12094-017-1797-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Accepted: 11/05/2017] [Indexed: 11/28/2022]
Abstract
INTRODUCTION This study aimed to describe the efficacy of fulvestrant 500 mg in postmenopausal women with estrogen receptor (ER)-positive advanced/metastatic breast cancer who had disease progression after receiving anti-estrogen therapy in clinical practice, getting real-world data. MATERIALS AND METHODS Multicenter, retrospective, observational study conducted in Spain. Postmenopausal women with locally advanced/metastatic ER-positive breast cancer who received treatment with fulvestrant 500 mg after progression with a previous anti-estrogen therapy were eligible. The primary endpoint was progression-free survival (PFS); secondary endpoints were overall survival (OS), clinical benefit rate (CBR), duration of clinical benefit (DoCB), and safety profile. RESULTS A total of 263 women were evaluated (median age, 65.8 years). At a median follow-up of 21.5 months, median PFS and OS were 10.6 and 43.2 months, respectively. PFS according to 1st, 2nd, 3rd, and ≥ 4th lines were 11.5, 10.6, 9.9, and 8.5 months, respectively (p = 0.0245). PFS in patients with visceral involvement was 10 months vs 10.6 months in patients without visceral involvement (p = 0.6604), 9.6 months in patients with high Ki67 vs 10 months in patients with low Ki67 (p = 0.7224), and 10.2 months in HER2+ patients vs 10.3 months in HER2- patients (p = 0.6809). The CBR was 56.5% and the DoCB was 18.4 months. The most frequently adverse events were injection site pain (10.3%) and musculoskeletal disorders (7.6%). CONCLUSIONS Fulvestrant 500 mg administered in clinical practice was shown to be effective (PFS, 10.6 months; CBR, 56.5%) and well tolerated, in accordance with previous trials.
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Affiliation(s)
- I Blancas
- Hospital Universitario Clínico San Cecilio, Complejo Hospitalario Universitario, C/Dr. Oloriz, 16, 18012, Granada, Spain.
| | - M Fontanillas
- Hospital Clinic de Barcelona, illarroel, 170, 08036, Barcelona, Spain
| | - V Conde
- Hospital Universitario Virgen de las Nieves, Av. de las Fuerzas Armadas, S/N, 18014, Granada, Spain
| | - J Lao
- Hospital Universitario Miguel Servet, Paseo Isabel la Católica, 1-3, 50009, Zaragoza, Spain
| | - E Martínez
- Hospital Provincial de Castellón, Av. del Dr. Clarà, 19, 12002, Castelló de la Plana, Spain
| | - M J Sotelo
- Hospital Universitario Clínico San Carlos, C/del Profesor Martín Lagos, s/n, 28040, Madrid, Spain
| | - A Jaen
- Hospital de Jaén, Avda. del Ejército Español, nº 10, 23007, Jaén, Spain
| | - J L Bayo
- Hospital Juan Ramón Jiménez, Ronda Exterior Norte s/n, 21005, Huelva, Spain
| | - F Carabantes
- Hospital Universitario Carlos Haya, Av. de Carlos Haya, s/n, 29010, Málaga, Spain
| | - J J Illarramendi
- Complejo Universitario Hospital de Navarra, Calle Irunlarrea, 3, 31008, Pamplona, Spain
| | - M M Gordon
- Hospital de Jerez, Ronda de Circunvalación s/n, 11407, Cádiz, Spain
| | - J Cruz
- Hospital Universitario de Canarias, Carretera de Ofra, s/n, 38320, Santa Cruz de Tenerife, Spain
| | - A García-Palomo
- Complejo Universitario Asistencial de León, C/Altos de Nava, s/n, León, Spain
| | - C Mendiola
- Hospital Universitario, 12 de Octubre, Avenida de Córdoba, s/n, 28041, Madrid, Spain
| | - E Pérez-Ruiz
- Hospital Costa del Sol, Autovia A-7, Km 187, 29603, Marbella, Spain
| | - J S Bofill
- Hospital Nuestra Señora De Valme, Av. de Bellavista, s/n, 41014, Seville, Spain
| | - J M Baena-Cañada
- Hospital Universitario Puerta del Mar, Av. Ana de Viya, 21, 11009, Cádiz, Spain
| | - N M Jáñez
- Hospital Ramón y Cajal, Ctra. de Colmenar Viejo, km. 9,100, 28034, Madrid, Spain
| | - G Esquerdo
- Clínica Benidorm, Av. Alfonso Puchades, 03501, Benidorm, Spain
| | - M Ruiz-Borrego
- Hospital Universitario Virgen del Rocío, Av. Manuel Siurot, s/n, 41013, Seville, Spain
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Flach KD, Zwart W. The first decade of estrogen receptor cistromics in breast cancer. J Endocrinol 2016; 229:R43-56. [PMID: 26906743 DOI: 10.1530/joe-16-0003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Accepted: 02/23/2016] [Indexed: 02/03/2023]
Abstract
The advent of genome-wide transcription factor profiling has revolutionized the field of breast cancer research. Estrogen receptor α (ERα), the major drug target in hormone receptor-positive breast cancer, has been known as a key transcriptional regulator in tumor progression for over 30 years. Even though this function of ERα is heavily exploited and widely accepted as an Achilles heel for hormonal breast cancer, only since the last decade we have been able to understand how this transcription factor is functioning on a genome-wide scale. Initial ChIP-on-chip (chromatin immunoprecipitation coupled with tiling array) analyses have taught us that ERα is an enhancer-associated factor binding to many thousands of sites throughout the human genome and revealed the identity of a number of directly interacting transcription factors that are essential for ERα action. More recently, with the development of massive parallel sequencing technologies and refinements thereof in sample processing, a genome-wide interrogation of ERα has become feasible and affordable with unprecedented data quality and richness. These studies have revealed numerous additional biological insights into ERα behavior in cell lines and especially in clinical specimens. Therefore, what have we actually learned during this first decade of cistromics in breast cancer and where may future developments in the field take us?
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Affiliation(s)
- Koen D Flach
- Division of Molecular PathologyThe Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Wilbert Zwart
- Division of Molecular PathologyThe Netherlands Cancer Institute, Amsterdam, The Netherlands
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Droog M, Beelen K, Linn S, Zwart W. Tamoxifen resistance: from bench to bedside. Eur J Pharmacol 2013; 717:47-57. [PMID: 23545365 DOI: 10.1016/j.ejphar.2012.11.071] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2012] [Revised: 11/20/2012] [Accepted: 11/23/2012] [Indexed: 01/09/2023]
Abstract
Although tamoxifen is a classical example of a targeted drug, a substantial proportion of estrogen receptor alpha positive breast cancer patients does not benefit from the drug. Over the last few decades, many potential biomarkers have been discovered in cell biological studies that may aid in the prediction of tamoxifen sensitivity and guide in treatment selection. Nonetheless, the transition of such a biomarker from the scientific community towards a diagnostic test that can be used in daily clinical practice has been far from ideal, and such markers seldom face clinical introduction. From a large number of potential predictive biomarkers as described in cell biological literature, the clinical (translational) scientist has to make a decision which of these biomarkers should be tested in clinical material to determine their clinical validity. This problem is not trivial, since patient samples with clinical follow-up are a valuable asset that should therefore be cherished. In this review, we will describe a number of 'cell biological biomarkers' for tamoxifen resistance and their possible clinical implications. This may guide the clinical scientist in choosing what potential biomarkers to test on tumour samples, which may catalyse the translation of scientific discoveries into daily clinical practice of breast cancer medicine.
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Affiliation(s)
- Marjolein Droog
- Department of Molecular Pathology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
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Gerber B, Freund M, Reimer T. Recurrent breast cancer: treatment strategies for maintaining and prolonging good quality of life. DEUTSCHES ARZTEBLATT INTERNATIONAL 2010; 107:85-91. [PMID: 20204119 PMCID: PMC2832109 DOI: 10.3238/arztebl.2010.0085] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2009] [Accepted: 06/17/2009] [Indexed: 01/07/2023]
Abstract
BACKGROUND Recurrent breast cancer remains a challenge for interdisciplinary treatment even though new therapeutic options are available. METHODS The PubMed database was selectively searched for articles that appeared from 1999 to 2009 and contained the key words "breast cancer," "recurrence," "metastatic," "advanced," and "treatment". Further sources consulted for this review included the German S3 guideline, the treatment recommendations of the German AGO-Mamma group, the NCCN guidelines, and the Cochrane database. RESULTS Locoregional recurrences are treated with curative intent. Metastatic breast cancer must be treated on an individualized basis: The treatment should be continued as long as its benefits for the individual patient outweigh its adverse side effects. Endocrine treatment is indicated for all patients whose tumors are hormone-receptor positive or of unknown receptor status and who have enough time for a response to be seen. Chemotherapy should be given if the tumor is hormone-receptor negative, if a rapid response is urgently needed, or if endocrine treatment has failed to produce a response. Combination chemotherapy improves response rates and prolongs progression-free survival, yet it does not prolong overall survival in comparison to monochemotherapy. In HER2-positive patients, first-line treatment with trastuzumab and monochemotherapy prolongs overall survival. Other treatment options include angiogenesis inhibitors, various tyrosine kinases inhibitors, radiotherapy, bisphosphonates, surgical or other ablative treatment of metastases, or a combination of these approaches, applied either simultaneously or consecutively. CONCLUSIONS While locoregional recurrences of breast cancer should be treated with curative intent, breast cancer with distant metastases is currently not curable. It is treated with the intention of restoring and maintaining good quality of life and relieving symptoms due to the metastases, rather than prolonging survival.
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Affiliation(s)
- Bernd Gerber
- Universitätsfrauenklinik am Klinikum Südstadt der Hansestadt Rostock, Germany.
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