Eribulin Mesylate

A Novel Halichondrin B Analogue for the Treatment of Metastatic Breast Cancer

Ali McBride, Pharm.D., M.S., BCPS; Sara K. Butler, Pharm.D., BCPS, BCOP

Disclosures

Am J Health Syst Pharm. 2012;69(9):745-755. 

In This Article

Place in Therapy

The role of eribulin in the clinical setting has yet to be realized. Based on the Phase II and III trials of eribulin monotherapy that have been published, eribulin has established a role in the metastatic setting in patients whose disease has progressed during therapy with taxanes and anthracyclines. An additional Phase III trial—Study 301—has completed patient accrual, enrolling 1102 patients who have either locally advanced or metastatic breast cancer and whose disease has progressed with three prior chemotherapy regimens (but no more than two regimens for locally advanced or metastatic disease).[28] These patients were randomized in a 2:1 fashion to receive eribulin or capecitabine. The results of this study, when published, will help determine the role of eribulin earlier in the treatment of metastatic breast cancer.

Eribulin's role in breast cancer treatment may also be marked by its low toxicity profile. Therapeutic options are often limited by compounded toxicities with other cardiotoxic agents. The use of anthracyclines and trastuzumab in frontline therapy may predispose patients to cardiomyopathy. However, eribulin has not been associated with heart failure. In heavily pretreated patients with peripheral neuropathy, continued use of antimicrotubule agents may be prohibitive. Neuropathy is associated with specific chemotherapy agents, the dose of chemotherapy agent in each regimen, the use of interacting medications, and the number of chemotherapy cycles.

Based on the mechanism of action of eribulin, the frequency of peripheral neuropathy has been a concern. Many patients with metastatic breast cancer already have peripheral neuropathy from previous treatments with taxane chemotherapy in the adjuvant or metastatic setting. While further study is needed, the results of studies to date indicate that while eribulin does cause peripheral neuropathy, the frequency of worsening peripheral neuropathy was similar to that of the development of peripheral neuropathy, meaning that eribulin may still be a treatment option in patients already suffering with peripheral neuropathy.

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