Is there an alternative drug after Fulvestrant/Fuxit expires?

Fulvestrant is a selective estrogen receptor degrader (SERD), mainly used to treat patients with estrogen receptor-positive (ER+), HER2-negative advanced or metastatic breast cancer. Its mechanism of action is by binding to estrogen receptors and promoting their degradation, thereby inhibiting estrogen-mediated cancer cell proliferation. In clinical practice, fulvestrant is usually used in patients who are resistant to tamoxifen or aromatase inhibitor (AI) therapy. However, for some patients, with long-term use or disease progression, the efficacy of fulvestrant may decrease or resistance may occur, in which case alternative or subsequent treatment options need to be considered.

The selection of alternative drugs after failure mainly depends on the patient's molecular characteristics and previous treatment history. For patients with ER+ breast cancer, common options include oral novel estrogen receptor degraders or modulators, such as oral SERD drugs, which have been shown to have some efficacy in patients resistant to fulvestrant in clinical studies. At the same time, CDK4/6 inhibitors (such as palbociclib, ribociclib) combined with aromatase inhibitors or Fulvestrant itself have also been proven to delay disease progression and are suitable for some drug-resistant patients. In addition, for patients with PI3K mutations or mTOR pathway abnormalities, a combination of PI3K inhibitors or mTOR inhibitors can also be used as a clinical alternative.

When choosing replacement drugs, the patient's general condition, liver and kidney function, and past adverse reactions should be taken into consideration to formulate a treatment plan. In actual clinical practice, doctors usually monitor disease progression through imaging evaluation and biomarkers, and dynamically adjust drug combinations based on the condition. It is worth noting that after fulvestrant resistance, hormone therapy is not given up immediately, but follow-up targeted drugs and combination regimens are scientifically selected to improve patient survival benefits and quality of life.

Reference materials:https://medlineplus.gov/druginfo/meds/a607031.html