From the Guidelines
Fulvestrant and paclitaxel is not a recommended combination therapy for metastatic breast cancer, as the use of combined endocrine therapy and chemotherapy is not supported by recent guidelines. The most recent guideline update from the American Society of Clinical Oncology 1 recommends against the use of combined endocrine therapy and chemotherapy, stating that "The use of combined ET and chemotherapy is not recommended". This recommendation is based on the lack of evidence showing a clinical advantage for the use of combined chemotherapy and endocrine therapy.
Instead, the guidelines recommend that treatment should be based on the biology of the tumor and the menopausal status of the patient, with careful attention paid to ovarian production of estrogen. For patients with hormone receptor-positive metastatic breast cancer, endocrine therapy is recommended as initial treatment, except in patients with immediately life-threatening disease or in those with rapid visceral recurrence on adjuvant endocrine therapy.
The combination of fulvestrant and paclitaxel may have been considered in the past, but recent studies have not shown a significant benefit for this combination. The 2021 ASCO guideline update 1 provides the most recent and highest quality evidence, and it does not support the use of fulvestrant and paclitaxel as a combination therapy.
Some key points to consider when treating metastatic breast cancer include:
- The use of endocrine therapy as initial treatment for patients with hormone receptor-positive disease
- The selection of endocrine therapy based on the biology of the tumor and the menopausal status of the patient
- The importance of monitoring patients regularly for signs of disease progression and side effects
- The consideration of clinical trials for patients with metastatic breast cancer, as new treatments and combinations are being developed and tested.
In terms of specific treatment options, fulvestrant is recommended to be administered using the 500 mg dose and with a loading schedule, as stated in the 2021 ASCO guideline update 1. However, the combination of fulvestrant and paclitaxel is not recommended, and other treatment options should be considered based on the individual patient's needs and disease characteristics.
From the Research
Treatment of Metastatic Breast Cancer
- Fulvestrant is a selective estrogen receptor degrader (SERD) that is approved for clinical use in estrogen receptor (ER) positive advanced breast cancer (ABC) 2.
- The combination of fulvestrant with CDK4/6 inhibitors has shown a clear benefit over monotherapy in patients who progress on prior endocrine therapy 2.
- However, there is no direct evidence in the provided studies to support the use of fulvestrant and paclitaxel as a viable combination to treat metastatic breast cancer.
Combination Therapies with Fulvestrant
- The addition of targeted therapies to fulvestrant resulted in clinically meaningful improvements in progression-free survival compared with fulvestrant alone 3.
- Fulvestrant combined with agents targeting mechanisms of endocrine resistance is a promising approach for the treatment of hormone receptor-positive advanced breast cancer (HR+ ABC) 3.
- The combination of fulvestrant and palbociclib was associated with significant improvements in progression-free survival compared with fulvestrant plus placebo in patients with metastatic breast cancer 4.
Efficacy and Safety of Fulvestrant
- Fulvestrant is generally well tolerated and has been shown to be effective in the treatment of postmenopausal women with advanced breast cancer that has progressed on prior antiestrogen therapy 5, 6.
- The optimal dose of fulvestrant is 500 mg monthly with a loading dose, which provides effective and well-tolerated second-line therapy for postmenopausal women with advanced breast cancer who have progressed following prior endocrine therapy 6.