Considerations in treatment choice for metastatic breast cancer

Eribulin Treatment in Patients with Liver Metastatic Breast Cancer: Eight Italian Case Reports

Liver metastases are very common in metastatic breast cancer (MBC); current treatments for these lesions are based on systemic chemotherapy, endocrine- or human epidermal growth factor receptor 2 (HER2)-targeted therapy, and palliative therapy. However, no standard approach has been clearly identified for second and further chemotherapy lines in MBC patients. In the phase III clinical trial EMBRACE, eribulin was particularly effective in reducing liver lesions and improving both overall survival and progression-free survival in liver MBC patients. In this series, we collected 8 case reports of Italian clinical practice in which eribulin has shown significant efficacy in reducing liver metastases in MBC patients: complete response was reported in 2 patients, and 4 patients achieved partial response. The treatment was well tolerated, thus confirming that eribulin is a suitable therapeutic option for elderly patients and for those who have metastatic HER2-negative disease. In the setting of MBC, the sequencing of therapeutic agents should consider expected response, side effects, tumor characteristics, and patient's preferences, in order to successfully tailor the most appropriate therapy beyond earlier lines.

Patient Management with Eribulin in Metastatic Breast Cancer: A Clinical Practice Guide

Eribulin, an antimicrotubule chemotherapeutic agent, is approved for the treatment of pretreated metastatic breast cancer (mBC) based on the positive outcomes of phase II and phase III clinical trials, which enrolled mainly Western patients. Eribulin has recently been approved in an increasing number of Asian countries; however, there is limited clinical experience in using the drug in certain countries. Therefore, we established an Asian working group to provide practical guidance for eribulin use based on our clinical experience. This paper summarizes the key clinical trials, and the management recommendations for the reported adverse events (AEs) of eribulin in mBC treatment, with an emphasis on those that are relevant to Asian patients, followed by further elaboration of our eribulin clinical experience. It is anticipated that this clinical practice guide will improve the management of AEs resulting from eribulin treatment, which will ensure that patients receive the maximum treatment benefit.

Long response to eribulin in breast cancer: a case report

No definitive cure is available for metastatic breast cancer and current therapies mainly focus on symptom control and minimization of adverse events to extend survival and maintain a good quality of life. Current treatment options include hormonal and chemotherapeutic agents which are characterized by different toxicity profiles and are selected based on patients’ performance status and prior therapies. Eribulin is a microtubule dynamic inhibitor which acts by sequestering tubulin molecules into aggregates, thus preventing microtubule growth and causing apoptosis. Many studies show that heavily pretreated metastatic breast cancer patients benefit from eribulin treatment both in terms of efficacy and for the favorable toxicity profile. In the Phase III EMBRACE study, eribulin treatment resulted in a significant improvement in overall survival. 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.

Response to eribulin in a difficult-to-treat, heavily pretreated breast cancer patient: a case report

In this short paper, we report our experience with eribulin mesylate in a heavily pretreated breast cancer patient with multiple bone metastases. The patient had been treated with doxorubicin, cyclophosphamide, methotrexate, fluorouracil, tamoxifen, letrozole, LH-RH analogs, fulvestrant, bevacizumab and paclitaxel and liposomal doxorubicin. In November 2013 treatment with eribulin ready to use solution (1.23 mg/m2 days 1 and 8 of a 21-day cycle) was started and administered for a total of 14 courses. After six cycles of eribulin, evaluation with MRI showed a marked decrease in neoplastic involvement and replacement of osteolytic lesions with osteoblastic ones. No unexpected acute toxicity was observed. Although with all the limitations of any anecdotal report, our experience documents the efficacy and safety of eribulin in this difficult-to-treat patient who had been treated with multiple lines of chemotherapy.

Efficacy and safety of palliative chemotherapy for patients with advanced breast cancer pretreated with anthracyclines and taxanes: a systematic review

No standard monotherapy or combination palliative chemotherapy currently exists for patients with advanced breast cancer pretreated with anthracyclines and taxanes. In this systematic review we assess the current knowledge on the efficacy and safety of palliative single-agent chemotherapy drugs--capecitabine, vinorelbine, gemcitabine, and liposomal doxorubicin--commonly used in daily clinical practice. We identified 22 studies, of which ten investigated capecitabine, nine investigated vinorelbine, three investigated gemcitabine, and one investigated liposomal doxorubicin. The greatest amount of information was available for capecitabine and vinorelbine. These two drugs showed good efficacy. The disease control rate differed significantly between the four drugs, which is relevant in terms of how well tumour symptoms can be improved and whether quality of life can be maintained or even improved. To obtain more evidence of the efficacy and safety of chemotherapeutic agents used in this pretreated population of advanced breast cancer patients, randomised comparisons of the various drugs, as monotherapy and in combination with targeted agents, are needed.

Vivências e discursos de mulheres mastectomizadas: negociações e desafios do câncer de mama

O presente artigo investiga as experiências de mulheres mastectomizadas tais como estas se presentificam em seus discursos sobre a vivência do câncer de mama, bem como suas estratégias de negociação dos desafios da doença. Foram analisadas 11 sessões de um grupo de apoio ocorridas em um serviço de atendimento público. A partir da análise temática das sessões, com o auxílio dos princípios do dialogismo e da polifonia, a partir do referencial histórico-cultural, pôde ser percebida a oposição entre o saber científico ("sentença" médica) e o saber popular (possibilidade de cura), bem como a questão do estigma social associado ao câncer e ao gênero feminino. O grupo constituiu-se como um espaço para que esses diferentes saberes se atualizassem e fossem transmitidos, refletindo uma construção coletiva das ideias em torno do câncer, o que permitiu ressignificar os modos de enfrentamento e as diversas vivências relacionadas à doença.

The costs of treating breast cancer in the US: a synthesis of published evidence

Published estimates for the treatment costs of breast cancer vary widely in methodology, perspective, patient populations and time horizon. We systematically summarized and analysed the published literature on per-patient costs of breast cancer, and highlight the perspectives, populations studied, time horizons and future directions for cost studies in breast cancer. This review included 29 US cost-of-illness studies for breast cancer. The estimates of lifetime per-patient costs of breast cancer ranged from $US20 000 to $US100 000. Payer perspectives were popular, while disease stages I and II were emphasized. The costs of initial and terminal therapy were greater than continuing care on a per-unit time basis, but continuing care accounts for the largest share of lifetime cost due to the relatively long survival of breast cancer patients. Costs of different surgeries were relatively similar (breast-conserving surgery vs mastectomy) but, all else equal, significant costs ($US23 000-31 000) were observed for patients who received adjuvant chemotherapy compared with those who did not. Multiple studies confirmed that costs increased with increased stage of disease and costs decreased with increased age of diagnosis. The question remains whether or not lower costs for elderly patients are associated with lower quality of care. The patient, employer and societal perspectives were rarely presented. Experts in the field have recommended the societal perspective for US-based cost-effectiveness analyses. Most lifetime cost estimates were likely an underestimate for today's lifetime cost of treating breast cancer because of changes in practice patterns and improved survival. Further societal-based cost studies that differentiate costs by stage, age and treatment time (initial, continuing and terminal), and include the latest practice patterns would be valuable toward informing US-based cost-effectiveness studies for preventive as well as breast cancer treatment interventions.