When would you consider adjuvant fulvestrant for ER+ breast cancer if the patient does not tolerate tamoxifen or any of the AIs?

While there are no trials that have assessed adjuvant fulvestrant versus placebo, we know from a small trial (GEICAM 2006-2010) that adjuvant fulvestrant plus anastrozole doesn’t add much when compared to adjuvant anastrozole. In this clinical setting, if the risk for distant recurrence is very high...

I have not thought about it or done it yet