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Improvements in survival among cancer patients have revealed the clinical impact of cardiotoxicity on both cardiovascular and hematological and oncological outcomes, especially when it leads to the interruption of highly effective antitumor therapies. Atrial fibrillation is a common complication in patients with active cancer and its treatment poses a major challenge. These patients have an increased thromboembolic and hemorrhagic risk but standard stroke prediction scores have not been validated in this population. The aim of this expert consensus-based document is to provide a multidisciplinary and practical approach to the prevention and treatment of atrial fibrillation in patients with active cancer. This is a position paper of the Spanish Cardio-Oncology working group and the Spanish Thrombosis working group, drafted in collaboration with experts from the Spanish Society of Cardiology, the Spanish Society of Medical Oncology, the Spanish Society of Radiation Oncology, and the Spanish Society of Hematology., (Copyright © 2019 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.)

Background and Objective: Fulvestrant (Flv) is a pure antiestrogen without agonist activity. Flv is effective as second line treatment in postmenopausal women with advanced breast cancer after tamoxifen., Material and Method: We performed a retrospective study of 36 consecutive postmenopausal women treated with Flv and advanced breast cancer progressing on prior therapies. 62,8% received Flv as third line treatment or more (all patients had previously received endocrine treatment for early or advanced breast cancer), 54,3% adjuvant chemotherapy and 67,5% received chemotherapy for metastatic disease. Our objective was to analyze the response rate, clinical benefit, time to progression (TTP) and toxicity profile., Results: In our study 11,4% patients had partial responses (PR) and 22,9% had a stable disease (SD) >24 weeks. Clinical benefit rate (CB) [RP+RC+SD]: 31,4%. TTP: 4,2 months (CI 95%, 2,6-5,8), with a median follow-up of 8,9 months. Flv was well tolerated, 22,9% patients had adverse events, all grade I/II, and only 5,7% of women gave up the treatment., Conclusions: These data demonstrate that Flv is an effective and safe therapy for heavily pre-treated postmenopausal women with advanced breast cancer.