Retinal metastasis regression with eribulin in a heavily pretreated breast cancer patient

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From: Future Oncology(Vol. 11, Issue 15s)
Publisher: Future Medicine Ltd.
Document Type: Clinical report
Length: 3,396 words
Lexile Measure: 1650L

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Author(s): Marta Gubbiotti aff1 , Barbara Pistilli [*] aff2 , Marianna Tudini aff3 , Giovanni Benedetti aff2 , Eva Galizia aff4 , Marco Rusiello aff2 , Luciano Latini aff2

KEYWORDS

brain metastases; breast cancer; eribulin; retinal metastases

Metastases to the retina are very rare findings, described in a limited number of case reports. The most common primary tumor causing retinal metastases is cutaneous melanoma, followed by lung cancer and breast cancer. The presence of retinal metastases can cause diverse symptoms, depending on the location and size of the lesion and ranging from decreased or blurred vision to floaters. The fundus examination of the eye generally demonstrates yellow-white intraretinal patches, sometimes associated with perivascular infiltration, intraretinal hemorrhage and subretinal exudates. Fluorescein angiography is usually performed to confirm clinical diagnosis. Several options have been evaluated for treatment of retinal metastases, although only limited visual improvement is generally achieved [1 ].

Approximately, 15-20% of patients with metastatic breast cancer will experience symptomatic brain metastases during the course of their disease. Brain metastases have recently emerged as a main challenge affecting the morbidity and mortality of patients with HER2-positive metastatic breast cancer treated with trastuzumab. This is probably due to the fact that trastuzumab does not easily cross the blood-brain barrier (BBB), and therefore has a limited role in the control of extra-CNS metastases. However, recent studies demonstrated that patients with brain metastases from HER2 - overexpressing breast cancer, when treated with anti-HER2 therapies, show prolonged survival and a prolonged time of CNS recurrence compared with those with brain metastases from HER2 disease. Several hypotheses have been considered to explain the survival advantage for patients with brain metastases deriving from HER2+ breast cancer: improved control of extracranial disease obtained with trastuzumab combined with chemotherapy; trastuzumab penetration in CNS at sites of local BBB disruption; better response of HER2+ brain metastases to cranial radiotherapy [2 ]. Eribulin mesylate is a nontaxane microtubule dynamics inhibitor which predominantly binds to high affinity sites on the growing plus (+) ends of microtubules, inhibiting microtubule polymerization without affecting depolymerization. Eribulin is approved for patients with metastatic breast cancer already treated with at least two chemotherapeutic regimens, including anthracyclines and taxanes in either the adjuvant or metastatic setting. Indeed, a large randomized Phase III trial, the EMBRACE study, demonstrated that eribulin significantly increases overall survival compared with treatment of physician's choice in women with heavily pretreated locally recurrent or metastatic breast cancer [3 ]. Another Phase III trial (Study 301) investigated the efficacy of eribulin in less heavily pretreated patients with recurrent or metastatic breast cancer, using capecitabine as control arm [4 ]. The study did not meet its primary end points as eribulin was not superior to capecitabine in terms of overall survival nor in progression-free survival [4 ]. According to the results of a recently published Phase II trial, the combination of eribulin with trastuzumab is an acceptable therapeutic option as first-line treatment for recurrent or metastatic HER2+ breast cancer patients. The combination resulted in high overall response rate, prolonged median progression-free...

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Gale Document Number: GALE|A423986993