Arimidex With or Without Faslodex In Postmenopausal Women With HR Positive Breast Cancer
Status:
Completed
Trial end date:
2018-12-05
Target enrollment:
Participant gender:
Summary
Over the last 3 decades, a steady shift has occurred in the management of breast cancer.
Because it was traditionally viewed as a local disease, many advocated the use of radical
surgery to achieve maximum survival benefit. This view has been slowly replaced by a broader
biologic view that recognizes the often systemic nature of breast cancer, even when it
appears to be localized to the breast. Results from randomized clinical trials have
demonstrated that less extensive surgery, or lumpectomy plus radiation therapy, are optimal
for local management of early breast cancer. In addition to the less radical approach to
surgical treatment of breast cancer, other randomized clinical trials have established the
value of postoperative systemic therapy in improving overall survival by eradicating
micrometastatic disease, the major cause of mortality from breast cancer. Despite the
well-documented benefits of adjuvant systemic therapy, it is not effective in preventing
death from breast cancer in all patients who are candidates for such treatment. The worth of
such therapy can only be judged in retrospect upon disease relapse, a time when breast cancer
is nearly always incurable. Currently, there are few reliable methods to predict the success
or failure of a particular postoperative treatment modality, and better ways to predict and
optimize outcome are needed.
Combination endocrine therapy: Using endocrine agents with different mechanisms of action
together has the potential advantage of more effectively blocking ER signaling, thus
improving the efficacy of such agents against breast cancer. In the past, attempts to combine
endocrine agents for ER-positive breast cancer have had mixed results, depending on the
setting and the patient population studied.
Endocrine agents without any agonist effect could potentially be used in combination with
aromatase inhibitors, under the rationale that the combination would maximally blockade
estrogen receptor signaling, thus potentially improving the antitumor effect. Fulvestrant
(FASLODEX) is a pure estrogen antagonist with no known agonist effect; thus, it has the
potential to provide additional benefit when combined with an aromatase inhibitor. This
concept provides the rationale for using the combination of anastrazole and fulvestrant in
this study.