Effect of eribulin on patients with metastatic breast cancer: multicenter retrospective observational study in Taiwan
Kun‑Ming Rau
Effect of eribulin on patients with metastatic breast cancer: multicenter retrospective observational study in Taiwan
0 Ming-Feng Hou
1 Division of Hematology-Oncology, Kaohsiung Chang Gung Memorial Hospital , No. 123, Dapi Rd, Niaosong Dist., Kaohsiung 833, Taiwan (ROC)
2 Department of Surgery, Kaohsiung Municipal Hsiao-Gang Hospital , No. 482, Shanming Rd, Siaogang Dist., Kaohsiung 812, Taiwan (ROC)
3 Kun-Ming Rau
4 Department of Surgery, Faculty of Medicine, College of Medicine, Kaohsiung Medical University , No. 100, Tzyou 1st Road, Kaohsiung 807, Taiwan (ROC)
5 Department of Surgery, Kaohsiung Municipal Ta-Tung Hospital , No. 68, Zhonghua 3rd Rd., Qianjin Dist., Kaohsiung 801, Taiwan (ROC)
6 Department of Surgery, Changhua Christian Hospital , No. 135, Nanxiao St., Changhua 500, Taiwan (ROC)
7 Division of Hematology-Oncology, Taipei Medical University- Shuang Ho Hospital , No. 291, Zhongzheng Rd., Zhonghe District, New Taipei City 23561, Taiwan (ROC)
8 Department of Surgery, National Cheng-Kung University Hospital , No. 138, Sheng Li Road, Tainan 704, Taiwan (ROC)
9 Division of Medical Oncology, Taipei Veterans General Hospital , No. 201, Sec. 2, Shipai Rd, Beitou District, Taipei 11217, Taiwan (ROC)
10 Division of Breast Surgery, Department of Surgery, Kaohsiung Medical University Hospital , No. 100, Tzyou 1st Road, Kaohsiung 807, Taiwan (ROC)
Purpose The aim of this study was to confirm the therapeutic role of eribulin on Taiwanese women with metastatic breast cancer. Methods This retrospective study examined 449 females who received eribulin between March 2014 and June 2017 at 14 hospitals in Taiwan for treatment of locally advanced or metastatic breast cancer. Results The survival rate at 24 months was 57.2% (95% CI 51.0-62.9%) and the median time to treatment failure (TTF) was 3.91 months (95% CI 3.45-3.94). A total of 175 patients (40.1%) received eribulin for fewer than 90 days and the others received it for 90 days or more. Eight patients (1.83%) had complete remission, 82 (18.8%) had partial remission, 202 (46.3%) had stable disease, and 144 (33.0%) had progressive disease (PD). Patients' tumors with the luminal A subtype had a significantly better objective response rate. Kaplan-Meier analysis indicated that hormone receptor positivity, luminal A subtype, receipt of eribulin as the 1st to 3rd line therapy, and metastasis to fewer than 4 organs were significantly associated with longer TTF. Stepwise multivariate analysis showed that only receipt of eribulin as the 1st to 3rd line therapy was significantly associated with TTF (HR 1.49, p < 0.001). All toxicities were manageable and only 18 patients (4.1%) discontinued treatment due to adverse events. Conclusions Eribulin appears to have better efficacy and cause fewer adverse events, especially neutropenia, in Taiwanese women than Western women. Extended author information available on the last page of the article Vol.:(011233456789)
Eribulin; Metastatic breast cancer; Efficacy; Safety; Real world; Taiwanese women
Introduction
Breast cancer is the most common cancer among women
worldwide, and approximately 10% of newly diagnosed
cases are stage IV (metastatic) [
1
]. Several treatments are
available for patients with metastatic breast cancer (MBC),
but none of them are curative treatments, so these patients
Kun-Ming Rau, Fu Ou-Yang and Ta-Chung Chao have contributed
equally to this work.
tend to have poor long-term survival rates, with median
survival times of 18–24 months [
2
]. The goals of most
treatments of these patients are palliation and improvement in the
quality of life. Taxanes and anthracyclines are the standard
adjuvant and first-line treatments for women with MBC,
but these treatments are not always successful due to the
development of drug resistance [
3
]. Thus, it is difficult to
treat patients after failure of these therapies, and there are
no established regimens for subsequent treatment.
Microtubules have an important function in the mitosis
of normal and cancer cells. Thus, several agents that
target microtubules are used to treat different cancers. These
include paclitaxel and docetaxel, which prevent microtubule
depolymerization, and vincristine and vinblastine, which
inhibit microtubule formation [
4
]. These drugs disrupt
normal function of microtubule during mitosis, leading to
cell death.
Eribulin (MW: 826.0, C40H59NO11. CH4O3S) is an
antitubulin agent that was first isolated from a marine sponge
[
5
]. Studies of its mechanism of action indicated that, in
contrast to other microtubule-targeting agents, eribulin
prevents the formation of cross-links between different
sulfhydryl groups in β-tubulin [
6
]. Thus, eribulin inhibits
microtubule growth, leading to an accumulation of non-functional
aggregates of tubulin, and then mitosis arrests at metaphase/
anaphase. In addition, studies of several lines of cancer cells
indicated that eribulin has additive or synergistic effects with
other an (...truncated)