Eribulin: Heavily pretreated breast cancer: uncertain advantages, excessive adverse effects

There is no standard treatment for women with metastatic breast cancer in whom multiple lines of chemotherapy, including anthracycline- and taxane-based regimens, have failed. Eribulin is now authorised for this indication in the European Union. Like taxanes, eribulin inhibits microtubule function. Initial evaluation is mainly based on a randomised controlled, but unblinded, trial comparing eribulin with various standard regimens chosen by the investigators. The median overall survival time was 2.7 months longer with eribulin (13.2 versus 10.5 months, a statistically significant difference), while the time to cancer progression did not differ. The adverse effect profile of eribulin in this trial was similar to that of taxanes; neutropenia and peripheral neuropathy were the most frequent adverse effects. Several other adverse effects, including asthenia, loss of appetite and pain, affect quality of survival. In practice, the benefits of eribulin are uncertain and are currently outweighed by adverse effects. It is better to avoid eribulin and to focus on symptomatic treatment.