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Table of Contents
LETTER TO EDITOR
Year : 2020  |  Volume : 3  |  Issue : 3  |  Page : 662

Fulvestrant in the fight against ER-positive advanced breast cancer; lone soldier or an important partner?


Department of Medical Oncology, Christian Medical College, Vellore, Tamil Nadu, India

Date of Submission19-Jul-2020
Date of Decision21-Jul-2020
Date of Acceptance22-Jul-2020
Date of Web Publication19-Sep-2020

Correspondence Address:
Ashish Singh
Department of Medical Oncology, Christian Medical College, Vellore, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/CRST.CRST_249_20

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How to cite this article:
Singh A. Fulvestrant in the fight against ER-positive advanced breast cancer; lone soldier or an important partner?. Cancer Res Stat Treat 2020;3:662

How to cite this URL:
Singh A. Fulvestrant in the fight against ER-positive advanced breast cancer; lone soldier or an important partner?. Cancer Res Stat Treat [serial online] 2020 [cited 2020 Oct 30];3:662. Available from: https://www.crstonline.com/text.asp?2020/3/3/662/295499



We read with interest the article by Vaikundaraja et al.[1] that reports the outcomes of their patients with hormone-positive advanced breast cancer who received fulvestrant.

In this heavily pretreated population with advanced breast cancer, the authors report complete response, partial response, stable disease, progressive disease, and unknown response in 0%, 11%, 30%, 19%, and 40% of the patients, respectively. Information on the prior use of chemotherapy and the number of agents used can to a certain extent justify the low response rate seen in this cohort.

In their study, two patients who received a single dose of fulvestrant were excluded. Moreover, further response assessment was not available in 40% of the patients who underwent treatment with fulvestrant. Was this due to patients not returning for assessments, or were they lost to follow-up before their first assessment? Were these patients excluded from the analysis for progression-free survival (PFS) and overall survival? Including these patients in the analysis could provide a more accurate estimate of the PFS. In this group, the authors could also consider looking into and reporting the median dose (cycles) of fulvestrant administered so as to assess the duration of therapy and the corresponding clinical benefit obtained with fulvestrant in these patients.

In this study, 38% of the patients received fulvestrant with another agent. The combination of fulvestrant with inhibitors of CDK4/6, mTOR, or PIK3CA is known to improve the PFS.[2] In practice, sometimes, fulvestrant is also combined with chemotherapeutic agents such as capecitabine.[3] Usually, the combination is considered to increase the rapidity of response in patients with high-volume disease. The contribution of the combination therapy, including chemotherapy to the longer-than-expected PFS of 11 months reported by the authors, should be examined.

Finally, we would like to commend the authors for this work and for providing information on the real-world use of an expensive hormonal agent, the use of which is still limited in India.[4]

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Vaikundaraja I, Dhanushkodi M, Radhakrishnan V, Kalaiarasi JP, Mehra N, Rajan AK, et al. Fulvestrant in hormone-positive advanced breast cancer: Real-world outcome. Cancer Res Stat Treat 2020;3:275-80  Back to cited text no. 1
    
2.
Harish P, Narayanan P. Fulvestrant: One step at a time? Cancer Res Stat Treat 2020;3:300-1  Back to cited text no. 2
    
3.
Rashad N, Abdelhamid T, Shouman SA, Nassar H, Omran MA, El Desouky ED, et al. Capecitabine-based chemoendocrine combination as first-line treatment for metastatic hormone-positive metastatic breast cancer: Phase 2 study. Clin Breast Cancer 2020;20:228-37.  Back to cited text no. 3
    
4.
Doval DC, Radhakrishna S, Tripathi R, Kashinath RI, Talwar V, Batra U, et al. A multi-institutional real world data study from India of 3453 non-metastatic breast cancer patients undergoing upfront surgery. Sci Rep 2020;10:5886.  Back to cited text no. 4
    




 

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