Clinical Medicine Reviews in Oncology

Fulvestrant (Faslodex®) is an estrogen receptor antagonist with no agonist effects that competitively binds to the estrogen receptor with greater affinity than tamoxifen. A systematic review was performed to understand the pharmacology and to examine the evidence supporting the clinical use of fulvestrant in the first-line and second-line settings in the treatment of advanced breast cancer. MEDLINE, American Society of Clinical Oncology proceedings, San Antonio Breast Cancer Symposia proceedings, and National Cancer Institute Clinical Trials were searched through October 2009 for trial reports. Data regarding tolerability and patient preference was also collected. Fulvestrant is currently being used in the second or third-line setting, and has similar efficacy to tamoxifen, non- steroidal and steroidal aromatase inhibitors based on clinical data. Though non-inferiority to tamoxifen in the first-line setting was not demonstrated in the overall population, clinical outcomes were similar in most settings. The incidence of adverse effects was low and quality of life assessments demonstrate excellent tolerability.