Fulvestrant for the treatment of locally advanced or metastatic breast cancer

Fulvestrant (Faslodex, AstraZeneca) is an oestrogen antagonist belonging to a class of agents known as selective oestrogen receptor down-regulators (SERDs). Fulvestrant has a UK marketing authorisation for 'the treatment of postmenopausal women with oestrogen receptor positive, locally advanced or metastatic breast cancer for disease relapse on or after adjuvant anti-oestrogen therapy, or disease progression on therapy with an anti-oestrogen'. The recommended dose is 500 mg (administered as 2 intramuscular injections of 250 mg) every month, with an additional 500 mg dose given 2 weeks after the initial dose.

According to the summary of product characteristics, the most common side effects associated with fulvestrant are nausea, vomiting, diarrhoea, venous thromboembolism, anorexia, headache, asthenia, urinary-tract infections, hot flushes, back pain, rash, injection-site reactions and hypersensitivity reactions (BNF, edition 61). For full details of side effects and contraindications, see the summary of product characteristics.

The current NHS list price of fulvestrant is £522.41 for 2×5 ml (250 mg) prefilled syringes (excluding VAT; BNF, edition 61). The first month of treatment with fulvestrant 500 mg includes an additional loading dose administered 2 weeks after the initial dose, resulting in a cost of £1,044.82 for the first month. In subsequent months, the cost of fulvestrant 500 mg is £522.41 per month. Costs may vary in different settings because of negotiated procurement discounts.