The Role of Fulvestrant in the Treatment of Metastatic Breast Cancer: A Case Report

Abstract

Nowadays we cannot find a cancer, in which the targeted therapy based on targeted diagnostics (immunohistochemistry, FISH, etc.) would not stand in the centre of the investigations. Breast cancer is not an exception either. Although the optimally performed surgery and the adequately planned radiotherapy are still important elements in the treatment of breast cancer and the achievement of effective local tumor control but their role has essentially changed in the last few years. In the treatment of patient who has been suffering from breast cancer for years either with or without his/her knowledge, the surgery should not be performed as soon as possible but when the patient “benefits” the most from this procedure. If distant metastases are present the removal of the tumor from the breast which means only the tip of the iceberg is absolutely unnecessary or it is required only in special cases. Systemic tumor control can be reached only by medicinal treatment. Regarding these treatments the importance of endocrine therapies (antiestrogens, aromatase inhibitors, LH-RH analogues etc.) traditional and modern chemotherapies (antracyclines, taxanes, platinum and pyrimidine derivatives, eribulin etc.) and the targeted biological therapies (trastuzumab, lapatinib, bevacizumab, olaparib etc.) can be emphasized. The targets of these biological therapies are either extracellular or intracellular molecular targets, such as estrogen receptor (tamoxifen, anastrazole, letrozole, exemestane, fulvestrant etc.) HER2 (trastuzumab, lapatinib, etc.), VEGF (bevacizumab, etc.) PARP (olaparib). It is well-known that due to frequent hormone sensitivity of breast cancer drugs influencing the hormonal effect are very effective. From these the importance of fulvestrant is discussed in our article. Based on literature data fulvestrant proved to be efficient both in locally advanced and metastatic breast cancers even if it was administered not as first (or second) line therapy.