title: Fulvestrant for the treatment of endometrial cancer.
abstract: BACKGROUND
  About one third of patients with endometrial cancer (EC) relapse and face a limited prognosis, if surgery or radiotherapy are not feasible. The remaining therapeutic options are chemotherapy and endocrine therapy.
  
  
  METHODS
  This review summarizes the development of the first selective estrogen receptor (ER) down-regulator fulvestrant. This article provides its mechanism of action, pharmacokinetics and the available preclinical and clinical data. Furthermore, this review provides an overview of the market of treatments for recurrent or metastatic EC (RMEC) while also taking into account studies of fulvestrant in metastatic breast cancer.
  
  
  CONCLUSIONS
  Even if fulvestrant showed only marginal activity in two phase II trials, it shouldn't be abandoned but instead further developed in EC. Firstly, the dose of fulvestrant used in these trials was too low from today's point of view. Secondly, the available literature on other endocrine agents is full of limitations and does not provide a gold standard. Furthermore, given the activity of mTOR inhibitors in EC, there may also be synergistic effects, given the cross-regulation of ER and the PI3K/AKT/mTOR pathway. The authors suggest that a prospective, phase II trial in ER positive RMEC would help to further explore the efficacy and tolerability of fulvestrant together with a mTOR inhibitor.
authors.affiliation: a Department of Obstetrics and Gynecology , University Hospital Mainz , Mainz , Germany.
authors.forename: Marco Johannes
authors.initials: MJ
authors.lastname: Battista
authors.affiliation: a Department of Obstetrics and Gynecology , University Hospital Mainz , Mainz , Germany.
authors.forename: Marcus
authors.initials: M
authors.lastname: Schmidt
mesh_terms: D000818:Animals; D018931:Antineoplastic Agents, Hormonal / Q000009:adverse effects / Q000737:chemistry / Q000494:pharmacology / Q000627:therapeutic use*; D016889:Endometrial Neoplasms / Q000188:drug therapy* / Q000378:metabolism; D004958:Estradiol / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000737:chemistry / Q000494:pharmacology / Q000627:therapeutic use; D005260:Female; D000077267:Fulvestrant; D006801:Humans
chemical_list: D018931:Antineoplastic Agents, Hormonal; D000077267:Fulvestrant; D004958:Estradiol
keywords: Chemotherapy; endometrial cancer; estrogen receptor antagonist; fulvestrant; mTOR inhibitor; medroxyprogesterone acetate; megestrol acetate; selective estrogen receptor downregulator; tamoxifen