Eribulin use in MBC (Metastatic breast cancer) in resource limited setting

Abstract

Abstract Back ground Eribulin is an anticancer agent derived from halichondrins acts at the level of microtubules but the site is different from that of taxanes. EMBRACE trial showed that even after several lines of chemotherapy in MBC, eribulin offered survival advantage against treatment of physician’s choice with a more better effect in triple negative breast cancers. Cost and neutropenia are the chief limitations of eribulin therapy, thereby restricting usage in resource limited settings. Methods From a tertiary care charitable cancer institution of Eastern India from Jan 2017 to Feb 2019, 26 patients with MBC received Eribulin. 10 patients were triple negative, 3 were triple positive, rest were hormone receptor positive. ECOG PS ranged from 0-1 and all patients had extensive visceral involvement mandating chemotherapy. 3 patients received concomitant Trastuzumab. Results The median number of cycles administered were 8 (d1 and d8). 21 patients completed 6 cycles. Interval radiological assessment as per RECIST revealed PR in 4 patients, PD in 5 patients, SD in 17 patients with CR none. Filgrastim was given on day 2,3 and again repeated on day 8,9. None of the patients developed febrile neutropenia. Delay in cycle interval was noted in 3 patients, but none beyond 7 days. There were no incidence of peripheral neuropathy. 5 patients got this drug after anthracycline and taxane progression, while remaining patients got either after capecitabine or navelbine or both. Interestingly, line of therapy did not modify the response, nor did the receptor statu. Quality of life was better during treatment with eribulin compared to the QOL experienced during any of the previous therapy. Conclusion Considering ease of administration, no hypersensitivity issues, good safety profile, beneficial clinical response and maintenance of good QOL, this drug can be considered as a very suitable third line after taxane and anthracycline failure in MBC, with cost remaining the main challenge.