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Abstract
Background: Fulvestrant is a pure anti-estrogen hormonal agent formally lacking any estrogen-agonist activity. We analyze the effect(s) of fulvestrant treatment on estrogen target systems in hormone-sensitive advanced breast cancer patients.
Methods: Fifty-one patients (median age 65 [range 48 - 82] years) were enrolled. All patients received previous hormonal treatments, with 90.2% receiving ≥2 courses. Last hormonal treatment was exemestane, letrozole, anastrozole and other in 30-10-7-4/51 patients respectively. Median withdrawal time was 18 days (range 3–1456). Complete fasting lipid blood profile and coagulation indices were assessed before fulvestrant administration, every 3 months and at discontinuation time. Endometrial mucosa thickness was evaluated before fulvestrant administration and at end-study time.
Results: Patients received a median of 5 fulvestrant injections (range 3-19). We observed a partial response in one patient, disease stability in 21 and disease progression in 29 patients with a clinical benefit of 43.2% and a median time to progression of 5 [range 3-20] months. Total cholesterol levels significantly decreased during treatment (219.8 ± 45.3 vs 201.4 ± 42.1 mg/dl; p = 0.0054) together with LDL-cholesterol (129.7 ± 41.39 vs 112.3 ± 37.1 mg/dl; p = 0.018). HDL-cholesterol and triglycerides did not show significant changes. Reduction of total and LDL-cholesterol was independent from last hormonal treatment or treatment duration. All coagulation indices and mean endometrial mucosa thickness value did not vary.
Conclusions: we observed a lipid lowering effect of fulvestrant possibly related to an influence on lipid metabolism by a mechanism in which a role could be played by progesterone receptor.