Long-lasting control with eribulin in a taxane pretreated metastatic breast cancer patient

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Date: Aug. 2015
From: Future Oncology(Vol. 11, Issue 15s)
Publisher: Future Medicine Ltd.
Document Type: Report
Length: 2,628 words
Lexile Measure: 1790L

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Author(s): Monica Iorfida [*] aff1 , Manuelita Mazza aff1

KEYWORDS

breast cancer; eribulin; response

Eribulin mesylate (Halaven® , INN: eribulin mesilate, E7389) is a nontaxane microtubule dynamics inhibitor, synthetically derived from halichondrin B, a natural product isolated from the marine sponge Halichondria okadai [1,2 ]. Its particular mechanism of action differs from that of most commonly used chemotherapeutic agents that target tubulin, including taxanes, vinorelbine and epothilones [3 ]. In fact eribulin exerts its activity by predominantly binding to high affinity sites on the growing plus (+) ends of microtubules, thus inhibiting microtubule polymerization without affecting depolymerization and eventually leading to cellular apoptosis [1-6 ].

A randomized Phase III trial (EMBRACE) was conducted to assess the efficacy and safety of eribulin compared with treatment of physician's choice (TPC) in patients with locally recurrent or metastatic breast cancer (MBC) [ 7 ]. Patients were considered as heavily pretreated since they had received a median of four previous chemotherapy regimens including an anthracycline and a taxane. Treatment with eribulin mesylate (1.4 mg/m2 , days 1 and 8 of a 21-day cycle) was associated with a significant improvement in median overall survival (OS) compared with TPC (13.1 vs 10.6 months; hazard ratio: 0.81; 95% CI: 0.66-0.99; p = 0.041). These results were further confirmed by an updated analysis requested by regulatory authorities that reported a significant increase in OS for eribulin compared with TPC (13.2 vs 10.5 months; hazard ratio: 0.81; 95% CI: 0.67-0.96; p = 0.014). Thanks to these results, eribulin mesylate was approved by the US FDA for treatment of patients with MBC who have previously received at least two chemotherapies for the treatment of metastatic disease and an anthracycline and a taxane in either the adjuvant or metastatic setting [8 ]. The efficacy of eribulin in less heavily pretreated patients was investigated in another Phase III trial (Study 301), using capecitabine as control arm. The trial showed that eribulin was not superior to capecitabine in terms of OS (15.9 and 14.5 months, respectively) and progression-free survival (4.1 and 4.2 months, respectively) [9 ]. Data from the EMRBACE trial and the Study 301 were pooled in an analysis recently published by Twelves et al . The analysis confirmed that eribulin improves OS in different subgroups of MBC patients who had previously received an anthracycline and a taxane. In particular, it seems that the most significant improvement in OS was achieved by HER2-negative patients [10 ].

The efficacy of eribulin was also investigated in combination with trastuzumab as first-line therapy for HER2+ recurrent or metastatic breast cancer. The combination treatment was considered an acceptable therapeutic option in this population, given the high overall response rate (71.2%), prolonged median progression-free survival (11.6 months) and acceptable safety profile [11 ].

Here, we present the case of a HER2- , ER+ , PR- breast cancer patient with treatment-refractory metastatic disease receiving long-term treatment with eribulin and showing consecutive long-lasting regression and stable disease.

Case presentation

A 42-year-old premenopausal Caucasian woman without co-morbidities was diagnosed with ductal infiltrating...

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Gale Document Number: GALE|A423986991