Abstract 2898
Background
This Phase III, randomised, double-blind, multicentre trial (FALCON; NCT01602380) compared the selective estrogen receptor (ER) degrader (SERD) fulvestrant with anastrozole in patients with ER- and/or progesterone receptor-positive locally advanced or metastatic breast cancer who had not received prior hormonal therapy.
Methods
Patients were randomised 1:1 to fulvestrant (500 mg IM on Days 0, 14, 28, then each 28 days) or anastrozole (1 mg daily). The primary endpoint was progression-free survival (PFS), assessed via RECIST 1.1, surgery/radiotherapy for disease worsening, or death. Secondary endpoints were: overall survival (OS); objective response rate (ORR, complete response [CR] or partial response [PR]); duration of response (DoR); expected DoR (EDoR); clinical benefit rate (CBR; CR, PR, or stable disease ≥24 weeks); duration of clinical benefit (DoCB); expected DoCB (EDoCB); health-related quality of life (HRQoL); and safety.
Results
In total, 462 patients (fulvestrant, n = 230; anastrozole, n = 232) were randomised. The primary endpoint was met as shown by a statistically significant improvement in PFS with fulvestrant vs. anastrozole (hazard ratio 0.797 [95% confidence interval 0.637, 0.999]; p = 0.0486; median PFS, 16.6 vs. 13.8 months, respectively). Secondary outcomes are shown in the Table (OS maturity was 31% at a median follow-up of 25.0 months). Treatment impact on HRQoL was similar in both treatment groups. The most common adverse events were arthralgia (16.7% vs. 10.3%) and hot flushes (11.4% vs. 10.3%) for fulvestrant and anastrozole, respectively.
Conclusions
These results confirm the superior efficacy of fulvestrant over anastrozole in postmenopausal women with hormone receptor-positive locally advanced or metastatic breast cancer who have not received prior hormonal therapy.
Clinical trial identification
ClinicalTrials.gov identifier: NCT01602380
Legal entity responsible for the study
AstraZeneca
Funding
AstraZeneca
Disclosure
M.J. Ellis: Employment, leadership, stock or other ownership, patents, royalties or intellectual property - Bioclassifier LLC; Consulting or advisory role - AstraZeneca, Pfizer, Novartis, Celgene. K-L. Cheung: Honoraria, speakers bureau - Chugai: Research Funding–AstraZeneca. S. Noguchi: Honoraria, consulting or advisory role–AstraZeneca, Chugai, Nippon Kayaku, Novartis, Pfizer, Taiho; Research funding – AstraZeneca, Chugai, Nippon Kayaku, Novartis, Pfizer, Taiho, Takeda; Patents, royalties or intellectual property – Sysmex. L.M. Grinsted: Employment, stock or other ownership – AstraZeneca. M. Fazal: Employment – AstraZeneca. M. Stuart: Former employment, and current stock or other ownership – AstraZeneca; Current employment – Kingston Oncology Ltd. J.F. Robertson: Stock or other ownership – Oncimmune; Honoraria, consulting or advisory role, travel or expenses – AstraZeneca, Bayer AG; Research funding – AstraZeneca, Bayer AG, Novartis; Expert testimony – AstraZeneca. All other authors have declared no conflicts of interest.
| Secondary endpoint | Fulvestrant (N = 230) | Anastrozole (N = 232) | |
|---|---|---|---|
| OS maturity (% deaths) | 29.1% | 32.3% | Hazard ratio (95% CI) 0.88 (0.63, 1.22); p = 0.428 |
| ORR | 46.1% [89/193] | 44.9% [88/196] | Odds ratio (95% CI) 1.07 (0.72, 1.61); p = 0.729 |
| Median DoR | 20.0 months | 13.2 months | - |
| EDoR | 11.4 months | 7.5 months | Ratio (95% CI) 1.52 (1.23, 1.89); p < 0.001 |
| CBR | 78.3% [180/230] | 74.1% [172/232] | Odds ratio (95% CI) 1.25 (0.82, 1.93); p = 0.305 |
| CR | 3.0% [7/230] | 3.4% [8/232] | - |
| PR | 37.4% [86/230] | 35.3% [82/232] | - |
| SD ≥24 weeks | 37.8% [87/230] | 35.3% [82/232] | - |
| Median DoCB | 22.1 months | 19.1 months | - |
| EDoCB | 21.9 months | 17.5 months | Ratio (95% CI) 1.26 (1.13, 1.39); p < 0.001 |