Author(s): Karen Borgonovo [*] aff1 , Fausto Petrelli aff1 , Mary Cabiddu aff1 , Mara Ghilardi aff1 , Andrea Coinu aff1 , Silvia Seghezzi aff2 , Sandro Barni aff1
breast cancer; chemotherapy; eribulin
Breast cancer is the most common cancer in women. Thanks to improved detection and treatment, the incidence of breast cancer-related deaths in the USA and parts of Europe has declined during the last 25 years [1 ]. However, it is important to note that patients' treatment and survival is markedly influenced by the stage of the tumor, and that the development of metastatic disease will occur in a third of patients diagnosed with early stage disease [2 ]. Metastatic breast cancer (MBC) is not curable today and is associated with poor prognosis and a median overall survival of 23-31 months [3 ].
Currently available therapies mainly focus on symptom control and minimization of toxicities, with the aim of extending patients' survival and maintaining quality of life during treatment. One of the crucial elements to select the most appropriate treatment is represented by tumor genotype status in terms of presence of hormone receptors and overexpression of the HER2 gene.
Patients with MBC often receive systemic chemotherapy, which is particularly important especially in patients with hormone refractory, hormone receptor-negative or rapidly progressing metastatic disease [2,4 ]. Two of the main chemotherapy agents used as (neo)adjuvant or first-line metastatic treatment are taxanes and anthracyclines, which are unfortunately associated with frequent development of drug resistance upon tumor recurrence. Studies have reported that patients can benefit from third-line treatments as it can extend the time of disease control [5 ].
There is no standard regimen for patients with MBC who recur after treatment with anthracyclines and taxanes. However, several factors need to be taken into consideration to select the most appropriate treatment, such as pretreatment history, previous response, residual toxicity and tumor aggressiveness.
Other agents used in this setting of patients include capecitabine, eribulin and ixabepilone (approved by US FDA but not by EMA) [6-8 ]. It is also possible to retreat patients with an anthracycline (including liposomal doxorubicin) or taxane (including NAB-paclitaxel).
In particular, the mechanism of action of eribulin (Halaven® ; Eisai Inc., NJ, USA) is unique amongst other antimicrotubule agents [ 9,10 ], as it prevents microtubule growth by suppressing microtubule polymerization [10 ]. This action in turn sequester tubulin into unusual aggregates [ 10 ]. Further evidence on the use of eribulin in clinical practice appears necessary.
We report here the case of a patient who experienced a time to progression of several months with eribulin after three lines of chemotherapy and two lines of hormonal therapy.
A white Caucasian 59-year-old woman with no history of familiar breast carcinoma presented at our hospital after several months of occasional pain in the left breast. She was submitted to mammography, breast ultrasound and tru-cut biopsy of suspicious nodules (size 25 mm and 9 mm). The diagnosis was plurifocal invasive ductal carcinoma of the left breast. Other diagnostic examinations were done (bone scan, chest x-ray, chest CT scan, liver ultrasound). The...