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      Eribulin Treatment for Patients with Metastatic Breast Cancer: The UK Experience − A Multicenter Retrospective Study

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          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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          Most cited references26

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          Extending survival with chemotherapy in metastatic breast cancer.

          Metastatic breast cancer (MBC) remains essentially incurable, and goals of therapy include the palliation of symptoms, delay of disease progression, and prolongation of overall survival time without negatively impacting quality of life. Anthracycline and taxane-based therapies have traditionally shown the highest degree of activity in MBC. Though numerous randomized clinical trials have shown improvements in overall response rates, few have found clear survival benefits. In recent years, however, there has been a small but growing series of clinical trials demonstrating modest, but meaningful survival advantages in metastatic disease. A common feature in many of these trials has been the use of a taxane, and more recently, a taxane combined with an antimetabolite. In addition, the development of targeted biologic agents active against MBC, such as trastuzumab and bevacizumab, has demonstrated great potential for enhancing the effects of chemotherapy and producing meaningful survival improvements. The role of the taxanes, antimetabolites, and biologics in extending survival in MBC is discussed.
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            Eribulin monotherapy versus treatment of physician's choice in patients with metastatic breast cancer (EMBRACE): a phase 3 open-label randomised study.

            Treatments with survival benefit are greatly needed for women with heavily pretreated metastatic breast cancer. Eribulin mesilate is a non-taxane microtubule dynamics inhibitor with a novel mode of action. We aimed to compare overall survival of heavily pretreated patients receiving eribulin versus currently available treatments. In this phase 3 open-label study, women with locally recurrent or metastatic breast cancer were randomly allocated (2:1) to eribulin mesilate (1·4 mg/m(2) administered intravenously during 2-5 min on days 1 and 8 of a 21-day cycle) or treatment of physician's choice (TPC). Patients had received between two and five previous chemotherapy regimens (two or more for advanced disease), including an anthracycline and a taxane, unless contraindicated. Randomisation was stratified by geographical region, previous capecitabine treatment, and human epidermal growth factor receptor 2 status. Patients and investigators were not masked to treatment allocation. The primary endpoint was overall survival in the intention-to-treat population. This study is registered at ClinicalTrials.gov, number NCT00388726. 762 women were randomly allocated to treatment groups (508 eribulin, 254 TPC). Overall survival was significantly improved in women assigned to eribulin (median 13·1 months, 95% CI 11·8-14·3) compared with TPC (10·6 months, 9·3-12·5; hazard ratio 0·81, 95% CI 0·66-0·99; p=0·041). The most common adverse events in both groups were asthenia or fatigue (270 [54%] of 503 patients on eribulin and 98 [40%] of 247 patients on TPC at all grades) and neutropenia (260 [52%] patients receiving eribulin and 73 [30%] of those on TPC at all grades). Peripheral neuropathy was the most common adverse event leading to discontinuation from eribulin, occurring in 24 (5%) of 503 patients. Eribulin showed a significant and clinically meaningful improvement in overall survival compared with TPC in women with heavily pretreated metastatic breast cancer. This finding challenges the notion that improved overall survival is an unrealistic expectation during evaluation of new anticancer therapies in the refractory setting. Eisai. Copyright © 2011 Elsevier Ltd. All rights reserved.
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              The Landscape of Targeted Therapies in TNBC

              Triple negative breast cancer (TNBC) constitutes the most aggressive molecular subtype among breast tumors. Despite progress on the underlying tumor biology, clinical outcomes for TNBC unfortunately remain poor. The median overall survival for patients with metastatic TNBC is approximately eighteen months. Chemotherapy is the mainstay of treatment while there is a growing body of evidence that targeted therapies may be on the horizon with poly-ADP-ribose polymerase (PARP) and immune check-point inhibitors already established in the treatment paradigm of TNBC. A large number of novel therapeutic agents are being evaluated for their efficacy in TNBC. As novel therapeutics are now incorporated into clinical practice, it is clear that tumor heterogeneity and clonal evolution can result to de novo or acquired treatment resistance. As precision medicine and next generation sequencing is part of cancer diagnostics, tailored treatment approaches based on the expression of molecular markers are currently being implemented in clinical practice and clinical trial design. The scope of this review is to highlight the most relevant current knowledge regarding underlying molecular profile of TNBC and its potential application in clinical practice.
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                Author and article information

                Journal
                Oncology
                Oncology
                OCL
                Oncology
                S. Karger AG (Allschwilerstrasse 10, P.O. Box · Postfach · Case postale, CH–4009, Basel, Switzerland · Schweiz · Suisse, Phone: +41 61 306 11 11, Fax: +41 61 306 12 34, karger@karger.com )
                0030-2414
                1423-0232
                December 2022
                31 August 2022
                31 August 2022
                : 100
                : 12
                : 666-673
                Affiliations
                [1] aMedical Oncology, University Hospitals Birmingham Foundation Trust, Birmingham, UK
                [2] bDepartment of Medical Oncology, Guy's and St Thomas' NHS Foundation Trust, London, UK
                [3] cClinical Oncology, The Christie NHS Foundation Trust, Cancer Centre, Manchester, UK
                [4] dMolecular and Clinical Medicine, Division of Molecular and Clinical Medicine, Ninewells Hospital and Medical School, University of Dundee, Dundee, UK
                [5] eMedical Oncology, University Hospitals of Leicester, Leicester, UK
                [6] fClinical Oncology, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK
                [7] gMedical Oncology, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, UK
                [8] hClinical Oncology, Norfolk and Norwich University Hospitals NHS Trust, Norwich, UK
                [9] iClinical Oncology, Taunton and Somerset Foundation Trust, Taunton, UK
                [10] jOncology, Velindre University NHS Trust, Cardiff, UK
                [11] kDepartment of Oncology, University Hospitals of Leicester, Leicester, UK
                [12] lDivision of Cancer Sciences, The Christie NHS Foundation Trust, Cancer Centre, Manchester, UK
                [13] mOncology, Guy's and St Thomas' NHS Foundation Trust, London, UK
                [14] nClinical Oncology, Velindre University NHS Trust, Cardiff, UK
                [15] oMedical Oncology, University of Birmingham Clinical Trials Unit, Birmingham, UK
                Author notes
                Article
                ocl-0100-0666
                10.1159/000526140
                9808648
                36044833
                994d1289-3b93-4fff-ad5c-37b9fb7b8707
                Copyright © 2022 by The Author(s). Published by S. Karger AG, Basel

                This article is licensed under the Creative Commons Attribution-NonCommercial 4.0 International License (CC BY-NC). Usage and distribution for commercial purposes requires written permission.

                History
                : 2 December 2021
                : 20 June 2022
                : 2022
                Page count
                Figures: 6, References: 28, Pages: 8
                Funding
                Eisai Company Limited provided financial assistance for the statistical analysis of the data. Writing support was provided by Oxford PharmaGenesis Inc., Newtown, PA, USA and was funded by Eisai Inc., Nutley, NJ, USA. Role of the funding source: Eisai Company Limited provided financial assistance for the statistical analysis of the data. They were not involved in the study design/conception, development, analysis of data, or the writing of the manuscript. The authors had full access to the data and control of the final approval and decision to submit the manuscript.
                Categories
                Clinical Study

                eribulin,observation study,real-world data,metastatic breast cancer,older adults,second-line treatment

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