First-Line Fulvestrant for Advanced Breast Cancer

Estrogen receptor–positive advanced breast cancer is usually managed with endocrine therapy unless there is a heavy tumor burden (i.e., visceral crisis) or the tumor becomes refractory to endocrine manipulation. The optimal sequence of endocrine agents has been the subject of numerous clinical trials, though improvements in outcome with one sequence over another have often been difficult to discern. When fulvestrant was first approved, it was commonly used as second- or third-line therapy for advanced disease. However, clinical trials have demonstrated that it is as effective as other alternative endocrine agents when used as first-line therapy.

Now, investigators report the results of an industry-supported, randomized, open-label, phase II …