20% reduction in disease progression vs
ARIMIDEX® (anastrozole), a current standard treatment
option
Expanded approval supports initial use for
advanced breast cancer patients not previously treated with
endocrine therapy
AstraZeneca today announced that the US Food and Drug
Administration (FDA) has approved FASLODEX® (fulvestrant) 500mg as
monotherapy for expanded use in women with hormone-receptor
positive (HR+), human epidermal growth factor receptor 2 negative
(HER2-) advanced breast cancer, who have gone through menopause and
have not received previous endocrine therapy.1
The FDA approval is based on pivotal data from the Phase III
FALCON trial, which were published in the November 2016 issue of
The Lancet.2
Jamie Freedman, Executive Vice President, Head of the Oncology
Business Unit, AstraZeneca said: “We’re pleased that the landmark
FALCON trial results demonstrated the efficacy of FASLODEX as
initial monotherapy treatment for women who are living with HR+,
HER2- advanced breast cancer. This approval, building on more than
15 years of clinical experience, means more patients can have the
opportunity to receive FASLODEX earlier in the treatment
journey.”
Matthew Ellis, MD, PhD, Director of the Lester and Sue Smith
Breast Center, part of the NCI-designated Dan L Duncan
Comprehensive Cancer Center at Baylor College of Medicine said:
“This study provides evidence that using fulvestrant as the first
option for previously untreated hormone receptor-positive advanced
breast cancer will prolong the time before the disease advances and
alternative therapies are required.”
The FALCON trial was designed to demonstrate superiority and
included 462 postmenopausal women with HR+ metastatic or
locally-advanced breast cancer. The results showed a
statistically-significant increase in investigator-assessed median
progression-free survival (PFS), representing a 20% reduction
in the risk of disease progression or death determined by RECIST -
median PFS of 16.6 months in patients who received FASLODEX,
compared to 13.8 months in patients receiving the aromatase
inhibitor ARIMIDEX® (anastrozole) 1mg (HR: 0.797; 95% CI:
0.637-0.999; p=0.049).1
FASLODEX is a hormonal therapy that targets the estrogen
receptor (ER), which can influence the growth of HR+ metastatic
breast cancer (MBC), and helps to slow cancer growth by blocking
the ER and targeting it for degradation.1,3,4,5
The most common adverse reactions (≥10%) of any grade reported
in patients in the FASLODEX arm were arthralgia, hot flash,
fatigue, and nausea.1
First approved in 2002, FASLODEX has been used as a monotherapy
for the treatment of postmenopausal women with HR+ MBC whose cancer
has progressed following prior antiestrogen therapy.6 In 2016,
FASLODEX was approved by the FDA in combination with palbociclib,
for the treatment of women with HR+, HER2- advanced or MBC, whose
cancer has progressed after endocrine therapy.1,7
Important Safety Information About FASLODEX
Contraindications
- FASLODEX is contraindicated in patients
with known hypersensitivity to the drug or to any of its
components. Hypersensitivity reactions, including urticaria and
angioedema, have been reported in association with FASLODEX
Risk of Bleeding
- Because FASLODEX is administered
intramuscularly, it should be used with caution in patients with
bleeding diatheses, thrombocytopenia, or anticoagulant use
Hepatic Impairment
- FASLODEX is metabolized primarily in
the liver. A 250-mg dose is recommended in patients with moderate
hepatic impairment (Child-Pugh class B). FASLODEX has not been
evaluated in patients with severe hepatic impairment (Child-Pugh
class C)
Injection Site Reaction
- Use caution while administering
FASLODEX at the dorsogluteal injection site due to the proximity of
the underlying sciatic nerve. Injection site related events
including sciatica, neuralgia, neuropathic pain, and peripheral
neuropathy have been reported with FASLODEX injection
Embryo-Fetal Toxicity and Lactation
- Advise pregnant women of the potential
risk to a fetus. Advise females of reproductive potential to use
effective contraception during FASLODEX treatment and for 1 year
after the final dose. Advise lactating women not to breastfeed
during treatment with FASLODEX and for 1 year after the final dose
because of the potential risk to the infant
Immunoassay Measurement of Serum Estradiol
- Due to structural similarity of
fulvestrant and estradiol, FASLODEX can interfere with estradiol
measurement by immunoassay, resulting in falsely elevated estradiol
levels
Adverse Reactions
Monotherapy
- The most common adverse reactions
occurring in ≥5% of patients receiving FASLODEX 500 mg were:
injection site pain, nausea, bone pain, arthralgia, headache, back
pain, fatigue, pain in extremity, hot flash, myalgia, vomiting,
anorexia, diarrhea, asthenia, musculoskeletal pain, cough, dyspnea,
and constipation
- Increased hepatic enzymes (ALT, AST,
ALP) occurred in >15% of FASLODEX patients and were not
dose-dependent
Combination Therapy
- The most frequently reported serious
adverse reactions in patients receiving FASLODEX plus palbociclib
were infections (3%), pyrexia (1%), neutropenia (1%), and pulmonary
embolism (1%)
- The most common adverse reactions
(≥10%) of any grade reported in patients receiving FASLODEX 500 mg
plus palbociclib 125 mg/day were: neutropenia, leukopenia,
infections, fatigue, nausea, anemia, stomatitis, headache,
diarrhea, thrombocytopenia, constipation, vomiting, alopecia, rash,
decreased appetite, and pyrexia
Indications for FASLODEX
Monotherapy
FASLODEX is an estrogen receptor antagonist indicated for
the:
- Treatment of hormone receptor
(HR)-positive, human epidermal growth factor receptor 2
(HER2)-negative advanced breast cancer in postmenopausal women not
previously treated with endocrine therapy
- Treatment of HR-positive advanced
breast cancer in postmenopausal women with disease progression
following endocrine therapy
Combination Therapy
- FASLODEX in combination with
palbociclib is indicated for the treatment of HR-positive,
HER2-negative advanced or metastatic breast cancer in women with
disease progression after endocrine therapy
Please see full Prescribing Information with
Patient Information.
Important Safety Information About ARIMIDEX
- Prescription ARIMIDEX is only for
postmenopausal women. ARIMIDEX should not be taken if you are
pregnant because it may harm your unborn child. Do not take
ARIMIDEX if you are allergic to any of its ingredients
- Based on information from a study in
patients with early breast cancer, women with a history of
blockages in heart arteries (ischemic heart disease) who take
ARIMIDEX may have a slight increase in this type of heart disease
compared to similar patients who take tamoxifen
- ARIMIDEX can cause bone
softening/weakening (osteoporosis) increasing the chance of
fractures. In a clinical study in early breast cancer, there were
more fractures (including fractures of the spine, hip, and wrist)
with ARIMIDEX (10%) than with tamoxifen (7%)
- In a clinical study in early breast
cancer, some patients taking ARIMIDEX had an increase in
cholesterol. Skin reactions, allergic reactions, and changes in
blood tests of liver function have also been reported
- In the early breast cancer clinical
trial, the most common side effects seen with ARIMIDEX include hot
flashes, joint symptoms (including arthritis and arthralgia),
weakness, mood changes, pain, back pain, sore throat, nausea and
vomiting, rash, depression, high blood pressure, osteoporosis,
fractures, swelling of arms/legs, insomnia, and headache
- In advanced breast cancer trials, the
most common side effects seen with ARIMIDEX versus tamoxifen
include hot flashes, nausea, decreased energy and weakness, pain,
back pain, headache, bone pain, increased cough, shortness of
breath, sore throat, and swelling of arms and legs. Joint
pain/stiffness has been reported in association with the use of
ARIMIDEX
- ARIMIDEX should not be taken with
tamoxifen or estrogen-containing therapies
Approved Uses for ARIMIDEX
ARIMIDEX is approved for adjuvant treatment (treatment following
surgery with or without radiation) of postmenopausal women with
hormone receptor-positive early breast cancer.
ARIMIDEX is approved for the initial treatment of postmenopausal
women with hormone receptor-positive or hormone receptor-unknown
locally advanced or metastatic breast cancer and for the treatment
of postmenopausal women with advanced breast cancer that has
progressed following treatment with tamoxifen. Patients with
hormone receptor-negative disease and patients who did not
previously respond to tamoxifen therapy rarely responded to
ARIMIDEX.
For more information, see your doctor.
Please see full Prescribing Information.
NOTES TO EDITORS
About FALCON
The FALCON (Fulvestrant
and AnastrozoLe COmpared in
endocrine therapy Naïve advanced breast cancer) trial
is a Phase III, randomized, double-blind, multicenter trial
comparing the efficacy and tolerability profile of a 500mg dose of
FASLODEX plus placebo with a 1mg dose of ARIMIDEX plus placebo, in
postmenopausal women with HR+, locally-advanced or metastatic
breast cancer, who have not had prior endocrine therapy.2
The FALCON trial was designed, based on positive results from
the Phase II FIRST trial, which demonstrated a greater median
overall survival nearly six months longer with FASLODEX, when
compared to ARIMIDEX.8
About Advanced Breast Cancer or Metastatic Breast Cancer
(ABC/MBC)
Advanced/metastatic breast cancer refers to Stages III and IV
breast cancer. Stage III disease may be referred to as
locally-advanced breast cancer. MBC is the most advanced stage of
breast cancer (Stage IV), and occurs when cancer cells have spread
beyond the initial tumor site to other parts of the body outside of
the breast. Since there is no cure for MBC, the goal of current
treatment is to delay disease progression or death.9,10,11
It is estimated that in 2017, there will be approximately
153,000 women in the US living with MBC, and this number is
projected to increase to approximately 160,000 by the year
2020.12
About FASLODEX
FASLODEX is a medicine for postmenopausal women with hormone
receptor-positive (HR+) advanced breast cancer with disease
progression following endocrine therapy. When taken with
palbociclib, it’s used to treat postmenopausal women with hormone
receptor-positive, human epidermal growth factor receptor 2
(HER2)-negative advanced or metastatic breast cancer with disease
progression after endocrine therapy. FASLODEX is indicated for HR+,
HER2- advanced breast cancer in postmenopausal women not previously
treated with endocrine therapy.1
FASLODEX is a hormonal therapy that targets the estrogen
receptor (ER). The ER is a key driver of disease progression.
FASLODEX helps to slow tumor growth by blocking and degrading the
ER.1,3,4,5
About AstraZeneca in Oncology
AstraZeneca has a deep-rooted heritage in Oncology and offers a
quickly-growing portfolio of new medicines that has the potential
to transform patients’ lives and the Company’s future. With at
least six new medicines to be launched between 2014 and 2020, and a
broad pipeline of small molecules and biologics in development, we
are committed to advance New Oncology as one of AstraZeneca’s five
Growth Platforms focused on lung, ovarian, breast and blood
cancers. In addition to our core capabilities, we actively pursue
innovative partnerships and investments that accelerate the
delivery of our strategy as illustrated by our investment in Acerta
Pharma in hematology.
By harnessing the power of four scientific platforms –
Immuno-Oncology, Tumor Drivers and Resistance, DNA Damage Response
and Antibody-Drug Conjugates – and by championing the development
of personalized combinations, AstraZeneca has the vision to
redefine cancer treatment and one day eliminate cancer as a cause
of death.
About AstraZeneca
AstraZeneca is a global, science-led biopharmaceutical company
that focuses on the discovery, development and commercialization of
prescription medicines, primarily for the treatment of diseases in
three main therapy areas – Oncology, Cardiovascular & Metabolic
Diseases and Respiratory. The Company also is selectively active in
the areas of Autoimmunity, Neuroscience and Infection. AstraZeneca
operates in over 100 countries and its innovative medicines are
used by millions of patients worldwide. For more information,
please visit www.astrazeneca-us.com and follow us on
Twitter @AstraZenecaUS.
References
1. FASLODEX Full Prescribing Information. AstraZeneca
Pharmaceuticals LP Wilmington, DE.
2. Robertson JFR, Bondarenko IM, Trishkina E, et al,. Results
from the Phase III, randomised, double-blind, Fulvestrant 500 mg
versus anastrozole 1 mg for hormone receptor-positive advanced
breast cancer (FALCON): a randomised, double-blind, Phase 3 trial.
Lancet 2016. 388(10063):2997-3005.
3. Howell A. Is fulvestrant (“FASLODEX”) just another selective
estrogen receptor modulator? Int J Gynecol Cancer.
2006;16(2):521-523.
4. National Cancer Institute. Hormone Therapy for Breast Cancer
Fact Sheet. Available Online. Accessed August 2017.
5. Mehta RS, Barlow WE, Albain KS, et al. Combination
anastrozole and fulvestrant in metastatic breast cancer. N Engl J
Med. 2012 Aug 2;367(5):435-44.
6. AstraZeneca Press Release. FDA approves new indication for
FASLODEX® (fulvestrant). Available Online. Accessed August
2017.
7. FDA Approval Letter. U.S. Food and Drug Administration,
Silver Spring, MD Accessed August 2017.
8. Ellis MJ, et al. Fulvestrant 500 mg Versus Anastrozole 1 mg
for the First-Line Treatment of Advanced Breast Cancer: Overall
Survival Analysis From the Phase II FIRST Study. J Clin Oncol. 2015
Nov 10;33(32):3781-7. Accessed August 2017.
9. Cleveland Clinic. Diseases and Conditions: Breast Cancer.
Available Online. Last Updated September 5, 2013. Accessed August
2017.
10. Mayo Clinic. Breast Cancer Diagnosis. Available Online. Last
Updated August 16, 2016. Accessed August 2017.
11. American Cancer Society. What Is Advanced Cancer? Atlanta:
American Cancer Society; 2014. Available online. Accessed August
2017.
12. CancerMPact.Khapps.com: ONC-Prevalence of Metastatic Breast
Cancer in Women 2014-2020. Accessed August 2017.
US-11572 Last Updated 8/17
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