Fulvestrant is licensed and approved for use in Scotland for the treatment of postmenopausal women with oestrogen receptor positive, locally advanced or metastatic breast cancer who have had disease relapse on or after oral anti-oestrogen therapy.
In 2018, the Scottish Medicines Consortium approved a new class of oral treatment for metastatic breast cancer, Cyclin-dependent kinase (CDK) 4 and 6 inhibitors. CDK4/6 inhibitors reduce cellular proliferation by blocking progression of the cell from G1 into S phase of the cell cycle and can be used in combination with fulvestrant in patients who have already received at least one line of endocrine therapy for metastatic breast cancer. CDK4/6 inhibitors (CDK4/6i) currently approved for use in Scotland are abemaciclib, palbociclib and ribociclib. Within NHS Highland, the majority of patients currently receive palbociclib concurrently with fulvestrant.