Eribulin's Role in Triple-Negative Breast Cancer

Reshma L. Mahtani, DO:I think the benefits of eribulin in this patient are really illustrated well by the EMBRACE study. This study was an open-label phase III study in which approximately 700 patients, who had had at least 2 prior lines of chemotherapy in the metastatic setting and had been exposed to an anthracycline and a taxane in the adjuvant or metastatic setting, were randomized to eribulin at a dose of 1.4 mg/m²on days 1 and 8 every 21 days, or treatment of physician’s choice, which on the whole included chemotherapy treatment options. Those patients who were treated on the study showed an improvement in overall survival of about 2-and-a-half months associated with the use eribulin as opposed to physician’s choice chemotherapy.

I think these results are quite meaningful. As I mentioned, overall survival is an ambitious endpoint for any clinical trial. It’s tough to show a survival benefit in breast cancer mainly because patients live for many years and are exposed to multiple therapies after progression. This was very clinically meaningful for me to see a therapy that is associated with a survival benefit. In terms of tolerability, I would say that the therapy does offer certain advantages. It’s very quick. There’s a 5-minute infusion time that doesn’t require premedication and allows for patients to get in and out quickly from the infusion center. It’s a single agent, as mentioned. Given the balance of efficacy and toxicity, I would say that it’s been a therapy I’ve used quite a bit in my practice, especially in patients who have triple-negative disease.

The 301 study was a study that looked at the use of capecitabine versus eribulin in the metastatic setting for patients who had received 1, 2, or 3 lines of therapy. Overall, the study did not show a benefit to eribulin over capecitabine, although there was definitely a trend noted. When a subgroup analysis was done, it was shown that the patients who were triple-negative did have a benefit approximately on the order of 5 months over capecitabine with the use of eribulin. On this basis, I’ve tended to incorporate eribulin into my practice for patients with triple-negative disease earlier on if I can get it covered. The label indication is after 2 prior lines of chemotherapy in the metastatic setting. That being said, I think these data are meaningful to consider earlier use if insurance is not an issue.

Transcript edited for clarity.

A 55-year-old Woman With Advanced TNBC

June 2015

• Patient History
  • A postmenopausal 55-year-old African American woman who was first diagnosed with breast cancer 2 years ago after discovering a lump in her right breast
  • SH: active with 2 teenaged children
  • Imaging revealed the likelihood of a multifocal lesion (2.5 cm.) in the right breast and right axillary lymph node involvement
• Pathology findings from ultrasound-guided core needle biopsy:
  • Histologic grade 3 invasive ductal carcinoma
  • Hormone receptor status: ER(-), PR(-)
  • HER2(-) IHC, 0
• BRCA1/2testing, negative
• She underwent mastectomy followed by immediate reconstruction; 2 of 20 nodes positive
  • Surgical staging T2pN1M0
• Following surgery, she received adjuvant doxorubicin/cyclophosphamide followed by paclitaxel (12 weeks); pt. had difficulty completing CT due to significant diarrhea and CINV

October 2017

• Routine follow up at 18 months:
  • Patient reported having worsening cough and abdominal pain
  • Imaging revealed 3 lesions in her right lung (<2 cm) and several liver lesions
  • Biopsy confirmed metastatic TNBC
• She was started on treatment with gemcitabine/carboplatin; she required dose reduction for neutropenia; imaging at 3 months showed stable disease

May 2018

• Seven months after starting gemcitabine/carboplatin, imaging showed progression in a single right lung nodule (now 3.2 cm)
• After discussion of her therapy choices, the patient opted for treatment with capecitabine

August 2018

• Imaging at 3 months showed 4 new liver lesions
• She started treatment with eribulin 1.4 mg/m²IV on days 1 and 8 of each 21-day cycle
  • Two weeks after her first dose, she developed grade 3 neutropenia without fever