Comparison of fulvestrant versus tamoxifen for the treatment of advanced breast cancer in postmenopausal women previously untreated with endocrine therapy: A multinational, double-blind, randomized trial

Anthony Howell, John F R Robertson, Paul Abram, Mikhail R. Lichinitser, Richard M Elledge, Emilio Bajetta, Toru Watanabe, Charles Morris, Alan Webster, Isaiah Dimery, C. Kent Osborne

Research output: Contribution to journalArticle

314 Citations (Scopus)

Abstract

Purpose: To evaluate the efficacy and tolerability of fulvestrant (Faslodex; AstraZeneca Pharmaceuticals LP, Wilmington, DE), a new estrogen receptor (ER) antagonist that downregulates ER and has no agonist effects, versus tamoxifen, an antiestrogen with agonist and antagonist effects, for the treatment of advanced breast cancer in postmenopausal women. Patients and Methods: In this multicenter, double-blind, randomized trial, patients with metastatic/locally advanced breast cancer previously untreated for advanced disease were randomly assigned to receive either fulvestrant (250 mg, via intramuscular injection, once monthly; n = 313) or tamoxifen (20 mg, orally, once daily; n = 274). Patients' tumors were positive for ER (ER+) and/or progesterone receptor (PgR+), or had an unknown receptor status. Results: At a median follow-up of 14.5 months, there was no significant difference between fulvestrant and tamoxifen for the primary end point of time to progression (TTP; median TTP, 6.8 months and 8.3 months, respectively; hazard ratio, 1.18; 95% CI, 0.98 to 1.44; P = .088). In a prospectively planned subset analysis of patients with known ER+ and/or PgR+ tumors (∼78%), median TTP was 8.2 months for fulvestrant and 8.3 months for tamoxifen (hazard ratio, 1.10; 95% CI, 0.89 to 1.36; P = .39). The objective response rate for the overall population was 31.6% with fulvestrant and 33.9% with tamoxifen, and 33.2% and 31.1%, respectively, in the known hormone receptor-positive subgroup. Both treatments were well tolerated. Conclusion: In the overall population, between-group differences in efficacy end points favored tamoxifen, and statistical noninferiority of fulvestrant could not be demonstrated. However, in patients with hormone receptor-positive tumors, fulvestrant had similar efficacy to tamoxifen and was well tolerated.

Original languageEnglish (US)
Pages (from-to)1605-1613
Number of pages9
JournalJournal of Clinical Oncology
Volume22
Issue number9
DOIs
StatePublished - 2004
Externally publishedYes

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Tamoxifen
Breast Neoplasms
Estrogen Receptors
Therapeutics
Hormones
Neoplasms
Estrogen Receptor Modulators
fulvestrant
Intramuscular Injections
Progesterone Receptors
Population Groups
Down-Regulation
Pharmaceutical Preparations
Population
thymidine 5'-triphosphate

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

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Comparison of fulvestrant versus tamoxifen for the treatment of advanced breast cancer in postmenopausal women previously untreated with endocrine therapy : A multinational, double-blind, randomized trial. / Howell, Anthony; Robertson, John F R; Abram, Paul; Lichinitser, Mikhail R.; Elledge, Richard M; Bajetta, Emilio; Watanabe, Toru; Morris, Charles; Webster, Alan; Dimery, Isaiah; Osborne, C. Kent.

In: Journal of Clinical Oncology, Vol. 22, No. 9, 2004, p. 1605-1613.

Research output: Contribution to journalArticle

Howell, A, Robertson, JFR, Abram, P, Lichinitser, MR, Elledge, RM, Bajetta, E, Watanabe, T, Morris, C, Webster, A, Dimery, I & Osborne, CK 2004, 'Comparison of fulvestrant versus tamoxifen for the treatment of advanced breast cancer in postmenopausal women previously untreated with endocrine therapy: A multinational, double-blind, randomized trial', Journal of Clinical Oncology, vol. 22, no. 9, pp. 1605-1613. https://doi.org/10.1200/JCO.2004.02.112
Howell, Anthony ; Robertson, John F R ; Abram, Paul ; Lichinitser, Mikhail R. ; Elledge, Richard M ; Bajetta, Emilio ; Watanabe, Toru ; Morris, Charles ; Webster, Alan ; Dimery, Isaiah ; Osborne, C. Kent. / Comparison of fulvestrant versus tamoxifen for the treatment of advanced breast cancer in postmenopausal women previously untreated with endocrine therapy : A multinational, double-blind, randomized trial. In: Journal of Clinical Oncology. 2004 ; Vol. 22, No. 9. pp. 1605-1613.
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title = "Comparison of fulvestrant versus tamoxifen for the treatment of advanced breast cancer in postmenopausal women previously untreated with endocrine therapy: A multinational, double-blind, randomized trial",
abstract = "Purpose: To evaluate the efficacy and tolerability of fulvestrant (Faslodex; AstraZeneca Pharmaceuticals LP, Wilmington, DE), a new estrogen receptor (ER) antagonist that downregulates ER and has no agonist effects, versus tamoxifen, an antiestrogen with agonist and antagonist effects, for the treatment of advanced breast cancer in postmenopausal women. Patients and Methods: In this multicenter, double-blind, randomized trial, patients with metastatic/locally advanced breast cancer previously untreated for advanced disease were randomly assigned to receive either fulvestrant (250 mg, via intramuscular injection, once monthly; n = 313) or tamoxifen (20 mg, orally, once daily; n = 274). Patients' tumors were positive for ER (ER+) and/or progesterone receptor (PgR+), or had an unknown receptor status. Results: At a median follow-up of 14.5 months, there was no significant difference between fulvestrant and tamoxifen for the primary end point of time to progression (TTP; median TTP, 6.8 months and 8.3 months, respectively; hazard ratio, 1.18; 95{\%} CI, 0.98 to 1.44; P = .088). In a prospectively planned subset analysis of patients with known ER+ and/or PgR+ tumors (∼78{\%}), median TTP was 8.2 months for fulvestrant and 8.3 months for tamoxifen (hazard ratio, 1.10; 95{\%} CI, 0.89 to 1.36; P = .39). The objective response rate for the overall population was 31.6{\%} with fulvestrant and 33.9{\%} with tamoxifen, and 33.2{\%} and 31.1{\%}, respectively, in the known hormone receptor-positive subgroup. Both treatments were well tolerated. Conclusion: In the overall population, between-group differences in efficacy end points favored tamoxifen, and statistical noninferiority of fulvestrant could not be demonstrated. However, in patients with hormone receptor-positive tumors, fulvestrant had similar efficacy to tamoxifen and was well tolerated.",
author = "Anthony Howell and Robertson, {John F R} and Paul Abram and Lichinitser, {Mikhail R.} and Elledge, {Richard M} and Emilio Bajetta and Toru Watanabe and Charles Morris and Alan Webster and Isaiah Dimery and Osborne, {C. Kent}",
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T1 - Comparison of fulvestrant versus tamoxifen for the treatment of advanced breast cancer in postmenopausal women previously untreated with endocrine therapy

T2 - A multinational, double-blind, randomized trial

AU - Howell, Anthony

AU - Robertson, John F R

AU - Abram, Paul

AU - Lichinitser, Mikhail R.

AU - Elledge, Richard M

AU - Bajetta, Emilio

AU - Watanabe, Toru

AU - Morris, Charles

AU - Webster, Alan

AU - Dimery, Isaiah

AU - Osborne, C. Kent

PY - 2004

Y1 - 2004

N2 - Purpose: To evaluate the efficacy and tolerability of fulvestrant (Faslodex; AstraZeneca Pharmaceuticals LP, Wilmington, DE), a new estrogen receptor (ER) antagonist that downregulates ER and has no agonist effects, versus tamoxifen, an antiestrogen with agonist and antagonist effects, for the treatment of advanced breast cancer in postmenopausal women. Patients and Methods: In this multicenter, double-blind, randomized trial, patients with metastatic/locally advanced breast cancer previously untreated for advanced disease were randomly assigned to receive either fulvestrant (250 mg, via intramuscular injection, once monthly; n = 313) or tamoxifen (20 mg, orally, once daily; n = 274). Patients' tumors were positive for ER (ER+) and/or progesterone receptor (PgR+), or had an unknown receptor status. Results: At a median follow-up of 14.5 months, there was no significant difference between fulvestrant and tamoxifen for the primary end point of time to progression (TTP; median TTP, 6.8 months and 8.3 months, respectively; hazard ratio, 1.18; 95% CI, 0.98 to 1.44; P = .088). In a prospectively planned subset analysis of patients with known ER+ and/or PgR+ tumors (∼78%), median TTP was 8.2 months for fulvestrant and 8.3 months for tamoxifen (hazard ratio, 1.10; 95% CI, 0.89 to 1.36; P = .39). The objective response rate for the overall population was 31.6% with fulvestrant and 33.9% with tamoxifen, and 33.2% and 31.1%, respectively, in the known hormone receptor-positive subgroup. Both treatments were well tolerated. Conclusion: In the overall population, between-group differences in efficacy end points favored tamoxifen, and statistical noninferiority of fulvestrant could not be demonstrated. However, in patients with hormone receptor-positive tumors, fulvestrant had similar efficacy to tamoxifen and was well tolerated.

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