Eribulin effective in metastatic breast cancer, researchers find

An  international research team, led by Dartmouth's Peter A. Kaufman, MD, published findings in the Journal of Clinical Oncologydemonstrating that, while not superior to capecitabine, eribulin is an active and well-tolerated therapy in women with metastatic breast cancer (MBC) receiving this therapy as a first, second, or third line chemotherapy regimen. Additionally, these patients had all been previously treated with both an anthracycline and a taxane in either the adjuvant or metastatic setting. This study is the first to address the use of eribulin early in the course of metastatic breast cancer, specifically either the first or second line setting

 

"Additionally, it is of great interest that subset analysis suggests that eribulin may be particularly active and effective in triple negative MBC, which is known to be an aggressive subset of breast cancer, and one associated unfortunately with a particularly poor prognosis overall," said Kaufman.

Eribulin has been approved in numerous countries in the third line or latter setting for the treatment of MBC, and is increasingly widely used. It is the only chemotherapeutic agent shown to have a survival benefit for patients with MBC in the third line or latter chemotherapeutic setting. Given previous research findings, and now findings from this large international trial, there has been great interest from oncologists and other clinicians in the potential impact that eribulin might have earlier in the course of MBC.

This phase III randomized trial assigned 1,099 women who had previously been treated with an anthracycline or a taxane to either eribulin or capecitabine as their first, second, or third line chemotherapy for advanced MBC. Stratification factors were human epidermal growth factor receptor-2 (HER2) status and geographic region. Coprimary endpoints were overall survival and progression-free survival.

"While there is not a statistically significant difference in overall survival with eribulin in comparison to capecitabine, the median overall survival seen with eribulin is in fact numerically slightly superior to that of capecitabine," explained Kaufman.

Ref : http://jco.ascopubs.org/content/early/2015/01/20/JCO.2013.52.4892

Eribulin effective in metastatic breast cancer, researchers find  

Eribulin drug has minor added benefit in one patient group, indication of lesser benefit in others

In continuation of my update on Eribulin

Eribulin (trade name: Halaven) is approved for women with locally advanced or metastatic breast cancer in whom the disease has progressed despite prior drug therapy. The German Institute for Quality and Efficiency in Health Care (IQWiG) examined in a dossier assessment whether the drug offers an added benefit over the appropriate comparator therapy in these patient groups.

According to the findings, there are both positive and negative effects. There is proof of minor added benefit for one group of patients. For other groups, there are hints or indications of lesser benefit.

Second assessment of eribulin

IQWiG already presented a dossier assessment of eribulin in February 2012. The subsequent decision on the added benefit made by the Federal Joint Committee (G-BA) was limited until April 2014. In addition, the drug manufacturer meanwhile obtained approval for an expanded therapeutic indication: In March 2011 eribulin was only available for patients who have progressed further after at least two chemotherapeutic regimens. Since June 2014, however, the drug can already be used after one unsuccessful treatment attempt. Hence there were two reasons ─ independent from each other ─ for the reassessment of eribulin.

G-BA specified appropriate comparator therapies

When the G-BA specified the appropriate comparator therapy, it distinguished between several treatment situations: The first one refers to patients who are not eligible for further chemotherapy with a taxane or an anthracycline. In this situation, eribulin was to be compared with individual chemotherapy containing the drugs capecitabine or vinorelbine.

In patients for whom taxanes or anthracyclines are principally still an option, eribulin was to be compared with an individual chemotherapy containing a taxane or an anthracycline.

Eribulin drug has minor added benefit in one patient group, indication of lesser benefit in others

Eribulin mesylate drug may help extend lives of women with advanced breast cancer..

We know that, Eribulin (see structure E7389) is an investigational  anticancer drug. Eribulin was previously known as E7389.  Eribulin is currently being investigated by Eisai Co. for the third-line treatment of advanced breast cancer in patients who have been previously treated with anthracyclines, taxanes and capecitabine, as well as a variety of other solid tumors, including non-small cell lung cancer, prostate cancer and sarcoma.

Structurally, eribulin is a fully synthetic macrocyclic ketone analogue of the marine sponge natural product halichondrin B a potent mitotic inhibitor with a unique mechanism of action found in the Halichondria genus of sponges. Eribulin is a mechanistically-unique inhibitor of microtubule dynamics, exerting its anticancer effects by triggering apoptosis of cancer cells following prolonged mitotic blockage. A new synthetic route to E7389 was published in 2009.

Now   research team at the University of Leeds and St James's Institute of Oncology led an international trial of the new chemotherapy drug, eribulin mesylate. As per the claim by the researchers, average survival was typically 25 per cent longer for women who took eribulin mesylate.

In the EMBRACE trial, 762 patients with advanced breast cancer received either eribulin or standard cancer treatment. All of the patients had already been heavily treated with conventional therapies, but their disease had returned or spread to other parts of the body.  Researchers concluded that those who took the new drug lived for 13.1 months, on average, compared with 10.7 months for those on conventional chemotherapy. The drug was also well-tolerated by most patients. Researchers hope that these results may establish eribulin as a new, effective treatment for women with late-stage metastatic breast cancer (either single drug or in combination with other anticancer drug). The drug is not yet available for routine clinical treatment and is awaiting regulatory approval in the European Union, the US and Japan.

"Until now, there hasn't really been a standard treatment for women with such advanced breast cancer. For those women who have already received all of the recognised treatments, these are promising results, claims the lead investigator Professor Christopher Twelves...

Ref : http://www.asco.org/ASCOv2/Meetings/Abstracts?&vmview=abst_detail_view&confID=74&abstractID=50309

Mifepristone-eribulin combination clinically active in triple-negative breast cancer patients

Corcept Therapeutics Incorporated, a pharmaceutical company engaged in the discovery, development and commercialization of drugs that treat severe metabolic, oncologic and psychiatric disorders by modulating the effects of cortisol, today announced results of a multi-center Phase 1/2 dose-escalation study of mifepristone and chemotherapy drug eribulin (Halaven®) 

 Mifepristone (or RU-486)

eribulin (Halaven®)

that show it is well tolerated and clinically active in patients with triple-negative breast cancer. These results were published in the 2015 American Society of Clinical Oncology (ASCO) Annual Meeting Program (abstract e12070), which was released today.

“Triple-negative breast cancers are among the most aggressive and difficult to treat of all the breast cancer types. We are encouraged by the results we have seen using mifepristone to enhance the efficacy of chemotherapy in this patient population,” said Rita Nanda, MD, principal investigator and Associate Director, Breast Medical Oncology, University of Chicago Medicine. “Cancer patients abundantly produce the stress hormone cortisol, which can help tumor cells escape chemotherapy effectiveness when cortisol binds to the cells’ glucocorticoid receptors (GR). Because mifepristone also binds with tumor GR, we are postulating that mifepristone will lessen the cortisol activity in tumor cells and make chemotherapy more effective. Patients with triple-negative breast cancer need better treatments and we are hopeful that mifepristone when combined with chemotherapy, will benefit them.”

Researchers enrolled 13 metastatic breast cancer patients for the first phase of the study to determine the maximum tolerated dose of the mifepristone-eribulin combination. The results showed that the combination regimen was well-tolerated with evidence of clinical activity for patients with triple-negative breast cancer (TNBC). The recommended Phase 1/2 dose of 300 mg of mifepristone daily with 1.1./mg/m2 of eribulin showed no evidence of a drug-drug interaction and will be used in the next phase of the study. An additional 20 patients with GR-positive metastatic TNBC will be enrolled into the study’s efficacy phase.

Mifepristone-eribulin combination clinically active in triple-negative breast cancer patients

FDA Approves Halaven (eribulin mesylate) for the Treatment of Liposarcoma

The U.S. Food and Drug Administration today approved Halaven (eribulin mesylate), a type of chemotherapy, for the treatment of liposarcoma (a specific type of soft tissue sarcoma) that cannot be removed by surgery (unresectable) or is advanced (metastatic). This treatment is approved for patients who received prior chemotherapy that contained an anthracycline drug.

“Halaven is the first drug approved for patients with liposarcoma that has demonstrated an improvement in survival time,” said Richard Pazdur, M.D., director of the Office of Hematology and Oncology Products in the FDA’s Center for Drug Evaluation and Research. “The clinical trial data the FDA reviewed indicates that Halaven increased overall survival by approximately seven months, offering patients a clinically meaningful drug.”

FDA Approves Halaven (eribulin mesylate) for the Treatment of Liposarcoma

Halaven Approved for Advanced Soft Tissue Cancer ...............

 

In continuation of my update on Halaven (eribulin mesylate)

Halaven (eribulin mesylate) has been approved by the U.S. Food and Drug Administration as the first chemotherapy drug shown to improve survival in people with advanced liposarcoma, a type of soft tissue sarcoma (cancer).

The drug is sanctioned for people who have received prior chemotherapy with a drug that contained anthracycline, the agency said Thursday in a news release.

Soft tissue sarcoma occurs when cancer invades soft tissues, such as muscles, tendons, fat, blood vessels, lymph nodes, nerves and tissues that surround joints, the FDA said. Liposarcoma specifically affects fat, most often of the head, neck, arms, legs, trunk or abdomen.

Halaven was evaluated in clinical studies involving more than 140 people with liposarcoma that had spread (metastatic) or couldn't be removed surgically. Average survival among people who took Halaven was 15.6 months, compared to 8.4 months among those who took another chemotherapy drug, dacarbazine.

The most common side effects of Halaven included fatigue, nausea, hair loss, constipation, nerve damage, abdominal pain and fever. Other adverse reactions included a drop in germ-fighting white blood cells and decreased levels of the minerals potassium or calcium.

More serious side effects included deadly infection, nerve damage, harm to a pregnant woman's fetus, and dangerous heartbeat abnormalities, the FDA said.

Halaven Approved for Advanced Soft Tissue Cancer - Drugs.com MedNews

Specific sequence of drugs reduces cost of treating metastatic breast cancer while preserving quality of life

The researchers developed three different computer models to predict how a hypothetical set of 10,000 patients with specific types of metastatic breast cancer would respond to different sequences and types of chemotherapy. For this study, the patient's cancer was either no longer responding to hormone therapies (endocrine resistant) or was a type of the disease called triple-negative breast cancer.

Currently, there are many chemotherapy choices to treat metastatic breast cancer. Oncologists have some preferences of which drugs to use early in treatment, but there is little clear evidence on the best order in which to give the drugs. The researchers consulted oncologists and experts in the field to choose which chemotherapy drugs were preferred choices to include in the study.

Mimicking clinical practice, and based upon existing data, the researchers then assumed that if a person started treatment with one drug, they would change to a second-choice treatment after their cancer stopped responding to the first drug, or if the side effects weren't tolerable. The purpose of the study was to test whether putting the drugs in one sequence compared to another could keep the patient on treatment for similar times while decreasing their side effect and/or cost burden.

"The cost of cancer drugs in the U.S. has rapidly increased, even for generics. As a society, we urgently need more strategies to reduce cancer drug costs without compromising outcomes, and our analysis provides quantifiable evidence to help providers choose lower priced, but equally effective sequences of drugs," said Stephanie B. Wheeler, PhD, MPH, professor of health policy & management at UNC Gillings and associate director of community outreach and engagement at UNC Lineberger and corresponding author of the article. "More spending on cancer care does not necessarily confer greater health benefits."

The costs calculated in this study were inclusive of medical and nonmedical costs borne by patients, including lost productivity. In this simulation, after two years, nearly all women would have completed the first three sets of treatment, but the cancer would cause the death of about one-third of the women. Productivity days lost due to sickness were similar across chemotherapy sequences, so most of the cost difference was due to drug savings. In the simulation, patients were placed in three groups, depending on what treatments they had already received for earlier episodes of breast cancer.

Outcomes in the three groups were:

• For people who had not previously received the common chemotherapy drug categories, including a taxane (e.g., paclitaxel) or an anthracycline (e.g., capecitabine), treatment with paclitaxel then capecitabine followed by doxorubicin corresponded to the highest expected gains in quality of life and lowest costs.
• For people who had previously received a taxane and an anthracycline drug, treatment with carboplatin, followed by capecitabine, followed by eribulin, corresponded to the highest expected gains in quality of life and lowest costs.
• For people who had previously received a taxane but not an anthracycline, treatment sequences beginning with capecitabine or doxorubicin, followed by eribulin, were most cost-effective.

"The drugs we studied are already recommended and reimbursed for the treatment of metastatic breast cancer, but the optimal sequencing of them has been unclear, which has led to considerable variation in physician preference and practice. Our study suggests that treatment sequencing approaches that minimize costs early may improve the value of care," Wheeler said. "The implications of this study are fairly straightforward for medical oncologists and those developing value-based clinical pathways to implement in practice now."

UNC Lineberger's Katherine E. Reeder-Hayes, MD, MBA, MSc, section chief of breast oncology and associate professor of medicine at UNC School of Medicine and one of the study's authors, said the treatment choices for metastatic breast cancer are constantly changing, and new options for targeted therapy have emerged even since this study was conducted. "Many oncologists and patients find that there aren't any more targeted therapies that fit the cancer's molecular profiles, so they are left with the choice of a number of chemotherapy drugs that may feel pretty similar or have an unclear balance of pros and cons.

"In that scenario, I hope our study will help expand the framework that we use to make these decisions from one where we just think about the biologic action of the drug to one where we also consider the bigger picture of what the treatment experience is like for the patient, including their financial burden, investment of time, and side effects," Reeder-Hayes added. "The most potent drug isn't always the next best choice depending on what the patient values and wants to accomplish with their treatment."

Looking ahead, the researchers have developed a financial navigation program to further support patients in managing the out-of-pocket costs of their cancer care. This program has been effective and well received by patients, caregivers and providers. The team is currently scaling up the intervention in nine rural and non-rural oncology practices across North Carolina to understand how well it works in different care settings. Cancer patients who need financial support managing the cost of their cancer care are being recruited for this undertaking.

Ref : https://ascopubs.org/doi/10.1200/JCO.21.02473