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Jafri M, Kristeleit H, Misra V, Baxter M, Ahmed S, Jegannathen A, Jain A, Maskell D, Barthakur U, Edwards G, Walter HS, Walshaw R, Khan M, Borley A, Rea D. Eribulin Treatment for Patients with Metastatic Breast Cancer: The UK Experience - A Multicenter Retrospective Study. Oncology 2022; 100:666-673. [PMID: 36044833 PMCID: PMC9808648 DOI: 10.1159/000526140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 06/20/2022] [Indexed: 01/07/2023]
Abstract
INTRODUCTION This study examined real-world data from patients who received eribulin for metastatic breast cancer (MBC) collected from 14 hospitals across the UK. METHODS Anonymized data were collected retrospectively from patients with MBC who had received eribulin. The data included the hormone-receptor status, histological diagnosis, age, prior chemotherapy, response to eribulin, progression-free survival (PFS), and overall survival (OS). RESULTS Among 577 patients analyzed, the median age was 56 years, and most patients (73%) were estrogen-receptor positive. The median OS was 288 days (95% confidence interval [CI]: 261-315), and the PFS was 117 days (95% CI: 105-129). The median OS was higher among older patients (≥65 vs. <65 years: 325 days [95% CI: 264-385] vs. 285 days [95% CI: 252-317]; p = 0.028). The median OS was also higher in patients who received eribulin after fewer prior lines of chemotherapy (≤2 vs. >2 prior: 328 days [95% CI: 264-385] vs. 264 days [95% CI: 229-298]; p = 0.042). DISCUSSION/CONCLUSION These retrospective data suggest that eribulin can be successfully used in older patients with MBC. Eribulin treatment was more effective in earlier-line settings, which, while predictable, supports consideration of eribulin as a second-line treatment option.
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Affiliation(s)
- Mariam Jafri
- Medical Oncology, University Hospitals Birmingham Foundation Trust, Birmingham, UK,*Mariam Jafri,
| | - Hartmut Kristeleit
- Department of Medical Oncology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Vivek Misra
- Clinical Oncology, The Christie NHS Foundation Trust, Cancer Centre, Manchester, UK
| | - Mark Baxter
- Molecular and Clinical Medicine, Division of Molecular and Clinical Medicine, Ninewells Hospital and Medical School, University of Dundee, Dundee, UK
| | - Samreen Ahmed
- Medical Oncology, University Hospitals of Leicester, Leicester, UK
| | - Apurna Jegannathen
- Clinical Oncology, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK
| | - Ankit Jain
- Medical Oncology, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, UK
| | - David Maskell
- Clinical Oncology, Norfolk and Norwich University Hospitals NHS Trust, Norwich, UK
| | - Urmila Barthakur
- Clinical Oncology, Taunton and Somerset Foundation Trust, Taunton, UK
| | | | - Harriet S. Walter
- Department of Oncology, University Hospitals of Leicester, Leicester, UK
| | - Richard Walshaw
- Division of Cancer Sciences, The Christie NHS Foundation Trust, Cancer Centre, Manchester, UK
| | - Madeha Khan
- Oncology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Annabel Borley
- Clinical Oncology, Velindre University NHS Trust, Cardiff, UK
| | - Daniel Rea
- Medical Oncology, University Hospitals Birmingham Foundation Trust, Birmingham, UK,Medical Oncology, University of Birmingham Clinical Trials Unit, Birmingham, UK
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Coe F, Misra V, McCabe Y, Adderley H, Woodhouse L, Ayub Z, Wang X, Howell S, Ekholm M. Average duration of prior treatment lines predicts clinical benefit to eribulin chemotherapy in patients with metastatic breast cancer. Breast Cancer Res Treat 2021; 191:535-543. [PMID: 34843027 PMCID: PMC8831340 DOI: 10.1007/s10549-021-06438-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 10/25/2021] [Indexed: 12/24/2022]
Abstract
Purpose The aim of this study was to identify factors associated with progression-free survival (PFS) and overall survival (OS) in patients with metastatic breast cancer (MBC) treated with eribulin in a real-world setting, to improve information provision in those considering treatment. Methods Patients treated with eribulin for MBC at The Christie NHS Foundation Trust, Manchester, UK, between August 2011 and December 2018 were included (n = 439). Data were collected by retrospective review of medical records and electronic prescribing systems. Factors such as biological subtype, distant recurrence-free interval, previous lines of chemotherapy and the ‘average duration of previous treatment lines’ (ADPT) (calculated as: (date of initiation of eribulin–date of MBC) / the number of previous treatment lines in the metastatic setting) were evaluated for prognostic impact using Cox proportional hazards regression. Results In the full cohort, the median PFS and OS were 4.1 months (95% CI 3.7–4.4) and 8.6 months (95% CI 7.4–9.8), respectively. Outcomes were significantly inferior for those with triple-negative breast cancer (TNBC) (n = 92); PFSTNBC: 2.4 months (95% CI 2.1–3.0), p = < 0.001 and OSTNBC: 5.4 months (95% CI 4.6–6.6), p = < 0.001. ADPT was the only factor other than subtype significantly associated with PFS and OS. Longer ADPT was also significantly associated with PFS and OS in those with TNBC. For example, women in the lowest ADPT tertile (< 5.0 months) achieved a median OS of only 4.3 months, whereas those in the upper ADPT tertile (> 8.7 months) had a median OS of 12.1 months (p = 0.004). Conclusion Our results indicate that the ADPT lines is an important factor when predicting the outcome with eribulin chemotherapy in a palliative setting and that quantitative guidance on the likely PFS and OS with treatment can be provided using ADPT. Validation in additional cohorts is warranted.
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Affiliation(s)
- Faye Coe
- Department of Pharmacy, The Christie NHS Foundation Trust, Manchester, UK
| | - Vivek Misra
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK
| | - Yamini McCabe
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, UK
| | - Helen Adderley
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, UK
| | - Laura Woodhouse
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, UK
| | - Zaheen Ayub
- Department of Pharmacy, The Christie NHS Foundation Trust, Manchester, UK
| | - Xin Wang
- Department of Analytics and Statistics, Digital Services, The Christie NHS Foundation Trust, Manchester, UK
| | - Sacha Howell
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, UK
| | - Maria Ekholm
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, UK.
- Department of Oncology, Ryhov Hospital, Jönköping, Sweden.
- Institute of Biomedicine, Department of Laboratory Medicine, Sahlgrenska Center for Cancer Research, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.
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Twelves C, Bartsch R, Ben-Baruch NE, Borstnar S, Dirix L, Tesarova P, Timcheva C, Zhukova L, Pivot X. The Place of Chemotherapy in The Evolving Treatment Landscape for Patients With HR-positive/HER2-negative MBC. Clin Breast Cancer 2021; 22:223-234. [PMID: 34844889 DOI: 10.1016/j.clbc.2021.10.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 07/23/2021] [Accepted: 10/19/2021] [Indexed: 11/19/2022]
Abstract
Endocrine therapy (ET) for the treatment of patients with hormone receptor-positive/human epidermal growth factor receptor 2-negative (HR-positive/HER2-negative) metastatic breast cancer (MBC) has changed markedly over recent years with the emergence of new ETs and the use of molecularly targeted agents. Cytotoxic chemotherapy continues, however, to have an important role in these patients and it is important to maximize its efficacy while minimizing toxicity to optimize outcomes. This review examines current HR-positive/HER2-negative MBC clinical guidelines and addresses key questions around the use of chemotherapy in the face of emerging therapeutic options. Specifically, the indications for chemotherapy in patients with HR-positive/HER2-negative MBC and the choice of optimal chemotherapy are discussed.
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Affiliation(s)
- Chris Twelves
- Clinical Cancer Pharmacology and Oncology, Leeds Institute of Medical Research, University of Leeds and Leeds Teaching Hospitals Trust Leeds.
| | - Rupert Bartsch
- Department of Medicine 1, Division of Oncology, Medical University of Vienna, Austria
| | | | - Simona Borstnar
- Division of Medical Oncology, Institute of Oncology, Ljubljana, Slovenia
| | - Luc Dirix
- Medical Oncology, Sint-Augustinus Hospital, Antwerp, Belgium
| | - Petra Tesarova
- First Faculty of Medicine and General Teaching Hospital, Charles University, Prague, Czech Republic
| | | | | | - Xavier Pivot
- ICANS - Strasbourg Europe Cancerology Institute, Strasbourg, France
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Aogi K, Watanabe K, Kitada M, Sangai T, Ohtani S, Aruga T, Kawagichi H, Fujisawa T, Maeda S, Morimoto T, Sato N, Takao S, Morita S, Masuda N, Toi M, Ohno S. Clinical usefulness of eribulin as first- or second-line chemotherapy for recurrent HER2-negative breast cancer: a randomized phase II study (JBCRG-19). Int J Clin Oncol 2021; 26:1229-1236. [PMID: 33891194 PMCID: PMC8213561 DOI: 10.1007/s10147-021-01920-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 04/03/2021] [Indexed: 11/24/2022]
Abstract
Background Anthracycline (A) or taxane T-based regimens are the standard early-line chemotherapy for metastatic breast cancer (BC). A previous study has shown a survival benefit of eribulin in heavily pretreated advanced/recurrent BC patients. The present study aimed to compare the benefit of eribulin with treatment of physician’s choice (TPC) as first- or second-line chemotherapy for recurrent HER2-negative BC.
Methods Patients with recurrent HER2-negative BC previously receiving anthracycline and taxane AT-based chemotherapy in the adjuvant or first-line setting were eligible for this open-label, randomized, parallel-group study. Patients were randomized 1:1 by the minimization method to receive either eribulin (1.4 mg/m2 on day one and eight of each 21-day cycle) or TPC (paclitaxel, docetaxel, nab-paclitaxel or vinorelbine) until disease progression or unacceptable toxicity. The primary endpoint was progression-free survival (PFS). Secondary endpoints included time to treatment failure (TTF), overall response rate (ORR), duration of response, and safety (UMIN000009886). Results Between May 2013 and January 2017, 58 patients were randomized, 57 of whom (26 eribulin and 31 TPC) were analyzed for efficacy. The median PFS was 6.6 months with eribulin versus 4.2 months with TPC (hazard ratio: 0.72 [95% confidence interval (CI), 0.40–1.30], p = 0.276). Median TTF was 6.0 months with eribulin versus 3.6 months with TPC (hazard ratio: 0.66 [95% CI, 0.39–1.14], p = 0.136). Other endpoints were also similar between groups. The most common grade ≥ 3 adverse event was neutropenia (22.2% with eribulin versus 16.1% with TPC). Conclusions Eribulin seemed to improve PFS or TTF compared with TPC without statistical significance. Further validation studies are needed.
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Affiliation(s)
- Kenjiro Aogi
- Department of Breast Oncology, National Hospital Organization Shikoku Cancer Center, Kou 160, Minamiumemoto-machi, Matsuyama, Ehime, 791-0280, Japan.
| | - Kenichi Watanabe
- Department of Breast Surgery, National Hospital Organization Hokkaido Cancer Center, Sapporo, Japan
| | - Masahiro Kitada
- Breast Disease Center, Asahikawa Medical University Hospital, Asahikawa, Japan
| | - Takashi Sangai
- Department of Breast Thyroid Surgery, Kitasato University Hospital, Sagamihara, Japan
| | - Shoichiro Ohtani
- Department of Breast Surgery, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Tomoyuki Aruga
- Department of Breast Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - Hidetoshi Kawagichi
- Department of Breast Surgery, Matsuyama Red Cross Hospital, Matsuyama, Japan
| | - Tomomi Fujisawa
- Department of Breast Oncology, Gunma Prefectural Cancer Center, Ohta, Japan
| | - Shigeto Maeda
- Department of Surgery, National Hospital Organization Nagasaki Medical Center, Nagasaki, Japan
| | - Takashi Morimoto
- Department of Breast Surgery, Yao Municipal Hospital, Osaka, Japan
| | - Nobuaki Sato
- Department of Breast Oncology, Niigata Cancer Center Hospital, Niigata, Japan
| | - Shintaro Takao
- Department of Breast Surgery, Hyogo Cancer Center Hospital, Kobe, Japan
| | - Satoshi Morita
- Department of Biomedical Statistics and Bioinformatics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Norikazu Masuda
- Department of Surgery, Breast Oncology, National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - Masakazu Toi
- Department of Breast Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Shinji Ohno
- Breast Oncology Center, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
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Yuan P, Xu B. Clinical Utility of Eribulin Mesylate in the Treatment of Breast Cancer: A Chinese Perspective. BREAST CANCER-TARGETS AND THERAPY 2021; 13:135-150. [PMID: 33658845 PMCID: PMC7917473 DOI: 10.2147/bctt.s231298] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 01/12/2021] [Indexed: 12/23/2022]
Abstract
Eribulin mesylate, a synthetic derivative of the anti-mitotic agent halichondrin B, has a unique tubulin-based mechanism of action that is distinct from other anti-microtubule agents including taxanes and vinca alkaloids. Consistent with this unique activity, eribulin has shown clinical efficacy in patients with metastatic breast cancer (MBC) that progressed following prior taxane and anthracycline therapy. The evidence presented in this review indicates that eribulin represents a treatment option for patients with HER2-negative metastatic breast cancer. Improved survival outcomes and better tolerability compared with vinorelbine supported the first approval of eribulin in China in 2019; eribulin was approved for women with locally advanced/metastatic HER2-negative breast cancer after treatment failure with at least two chemotherapy regimens, including an anthracycline and a taxane. Eribulin has also shown promising efficacy in patients with HER2-positive advanced breast cancer when used in combination with trastuzumab or pertuzumab, and subgroup analyses from the Phase III clinical trials support the continued evaluation of eribulin in patients with triple-negative disease. The unique non-mitotic effects of eribulin, including vascular remodeling, coupled with its clinical efficacy and safety profile, may permit the broader use of this agent in patients with MBC.
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Affiliation(s)
- Peng Yuan
- National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, People's Republic of China
| | - Binghe Xu
- National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, People's Republic of China
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Pouwels XGLV, Ramaekers BLT, Geurts SME, Erdkamp F, Vriens BEPJ, Aaldering KNA, van de Wouw AJ, Dercksen MW, Smilde TJ, Peters NAJB, van Riel JMGH, Pepels MJ, Heijnen-Mommers J, Tjan-Heijnen VCG, de Boer M, Joore MA. An economic evaluation of eribulin for advanced breast cancer treatment based on the Southeast Netherlands advanced breast cancer registry. Acta Oncol 2020; 59:1123-1130. [PMID: 32544366 DOI: 10.1080/0284186x.2020.1775289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Background: In 2013, eribulin was reimbursed under a coverage with evidence development (CED) as third or later chemotherapy line for advanced breast cancer (ABC) patients in the Netherlands because of uncertain cost effectiveness. In 2016, the final decision of reimbursing eribulin was taken without considering the evidence collected during CED research. We analysed the cost effectiveness of eribulin versus non-eribulin chemotherapy, using real-world data.Methods: A three health states (progression-free, progressed disease, dead) partitioned survival model was developed. The SOuth East Netherlands Advanced BREast Cancer (SONABRE) registry informed the effectiveness and costs inputs. Health state utility values were obtained from the literature. Incremental cost-effectiveness ratio (ICER) between the eribulin and matched non-eribulin chemotherapy was estimated. Deterministic and probabilistic sensitivity analyses and scenario analyses were performed. The financial risk (i.e., the expected value of perfect information (EVPI) plus the expected monetary loss (eML) associated with reimbursing eribulin) and budget impact associated with reimbursing eribulin were calculated.Results: Eribulin led to higher health benefits (0.07 quality-adjusted life year (QALY)) and costs (€15,321) compared with non-eribulin chemotherapy. This resulted in an ICER of €220,608. At a €80,000 per QALY threshold, the risk of reimbursing eribulin was €9,791 per patient (EVPI €13, eML €9,778). Scaled up to the Dutch population, the estimated annual budget impact was €1.9 million and the annual risk of reimbursing eribulin was €2.7 million.Conclusion: From a Dutch societal perspective, eribulin is not cost effective when considering its list price as third and later chemotherapy line for ABC patients.
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Affiliation(s)
- Xavier G. L. V. Pouwels
- Department of Clinical Epidemiology and Medical Technology Assessment (KEMTA), Maastricht University Medical Centre +, Maastricht, The Netherlands
- Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
- School of Oncology and Developmental Biology (GROW), Maastricht University, Maastricht, The Netherlands
| | - Bram L. T. Ramaekers
- Department of Clinical Epidemiology and Medical Technology Assessment (KEMTA), Maastricht University Medical Centre +, Maastricht, The Netherlands
| | - Sandra M. E. Geurts
- School of Oncology and Developmental Biology (GROW), Maastricht University, Maastricht, The Netherlands
- Division of Medical Oncology, Department of Internal Medicine, Maastricht University Medical Centre +, Maastricht, The Netherlands
| | - Frans Erdkamp
- Department of Internal Medicine, Zuyderland Medical Centre, Sittard-Geleen, The Netherlands
| | | | | | | | - M. W. Dercksen
- Department of Internal Medicine, Máxima Medical Centre, Eindhoven, The Netherlands
| | - Tineke J. Smilde
- Department of Internal Medicine, Jeroen Bosch Hospital, Hertogenbosch, The Netherlands
| | | | - J. M. G. H. van Riel
- Department of Internal Medicine, Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands
| | - Manon J. Pepels
- Department of Internal Medicine, Elkerliek Hospital, Helmond, The Netherlands
| | - Jose Heijnen-Mommers
- School of Oncology and Developmental Biology (GROW), Maastricht University, Maastricht, The Netherlands
- Division of Medical Oncology, Department of Internal Medicine, Maastricht University Medical Centre +, Maastricht, The Netherlands
| | - Vivianne C. G. Tjan-Heijnen
- School of Oncology and Developmental Biology (GROW), Maastricht University, Maastricht, The Netherlands
- Division of Medical Oncology, Department of Internal Medicine, Maastricht University Medical Centre +, Maastricht, The Netherlands
| | - Maaike de Boer
- School of Oncology and Developmental Biology (GROW), Maastricht University, Maastricht, The Netherlands
- Division of Medical Oncology, Department of Internal Medicine, Maastricht University Medical Centre +, Maastricht, The Netherlands
| | - Manuela A. Joore
- Department of Clinical Epidemiology and Medical Technology Assessment (KEMTA), Maastricht University Medical Centre +, Maastricht, The Netherlands
- Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
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Cortes J, Twelves C. Impact of the number of prior chemotherapy regimens on outcomes for patients with metastatic breast cancer treated with eribulin: A post hoc pooled analysis. Breast J 2019; 26:1347-1351. [PMID: 31782589 PMCID: PMC7496313 DOI: 10.1111/tbj.13686] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 10/18/2019] [Indexed: 12/20/2022]
Abstract
In a pivotal phase 3 study (Study 305), eribulin mesylate improved overall survival (OS) in patients with previously treated metastatic breast cancer (MBC) compared with treatment of physician's choice (TPC). This post hoc, pooled subgroup analysis of two phase 3 studies (Study 305 and Study 301) reports the influence of the number of prior chemotherapy regimens (0‐6) on OS in patients with locally advanced/MBC randomized to eribulin versus TPC/capecitabine. Patients with ≤ 3 prior chemotherapies for locally advanced/MBC had longer median OS with eribulin (15.3 months) versus control (13.2 months; hazard ratio, 0.858; P = .01).
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Affiliation(s)
- Javier Cortes
- IOB Institute of Oncology, Quironsalud Group, Madrid & Barcelona, Spain.,Vall d´Hebron Institute of Oncology, Barcelona, Spain
| | - Chris Twelves
- Leeds Institute of Medical Research at St James's, University of Leeds and Leeds Teaching Hospitals Trust, Leeds, UK
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