J Cancer 2020; 11(14):4099-4105. doi:10.7150/jca.37670 This issue

Research Paper

Use of eribulin as an earlier-line chemotherapy for patients with HER2-negative metastatic breast cancer

Sumito Shingaki1,2, Takahiro Kogawa1,2,*,✉, Mototsugu Shimokawa4,5, Kenichi Harano1,2, Yoichi Naito1,2, Shota Kusuhara1, Yumi Fujimoto1, Nobuaki Matsubara1, Ako Hosono1, Hirofumi Mukai1, Tatsuya Onishi3, Takashi Hojo3, Toru Mukohara1

1. Departments of Breast and Medical Oncology, National Cancer Center Hospital East, Kashiwa, Japan
2. Department of Developmental Therapeutics, National Cancer Center Hospital East, Kashiwa, Japan
3. Department of Breast Surgery, National Cancer Center Hospital East, Kashiwa, Japan
4. Cancer Biostatistics Laboratory, Clinical Research Institute, National Kyushu Cancer Center, Fukuoka, Japan
5. Department of Biostatistics, Yamaguchi University Graduate School of Medicine, Ube, Japan
* Current affiliation is Division of Early Clinical Development for Cancer, Center for Advanced Medical Development, Japan Foundation Cancer Research

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Shingaki S, Kogawa T, Shimokawa M, Harano K, Naito Y, Kusuhara S, Fujimoto Y, Matsubara N, Hosono A, Mukai H, Onishi T, Hojo T, Mukohara T. Use of eribulin as an earlier-line chemotherapy for patients with HER2-negative metastatic breast cancer. J Cancer 2020; 11(14):4099-4105. doi:10.7150/jca.37670. Available from https://www.jcancer.org/v11p4099.htm

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Background: Previous prospective studies have shown that eribulin improves the survival in patients with metastatic breast cancer (MBC). However, the optimal timing of its administration to achieve the longest extended survival and the efficacy of using eribulin monotherapy as earlier-line chemotherapy are yet unclear.

Methods: We identified all consecutive female patients with MBC who received any chemotherapeutic intervention for metastatic disease at our institution between July 2012 and December 2017, excluding patients with HER2-positive disease. Those who received eribulin monotherapy for MBC were classified under the eribulin cohort, whereas those who never received eribulin were included in the non-eribulin (Non-E) cohort. Among the patients in the eribulin cohort, those who received eribulin as the first- or second-line chemotherapy for MBC were further classified under the earlier-line eribulin (EE), and otherwise classified under the later-line eribulin (LE) cohorts. The survival of patients was assessed using the log-rank test. A multivariable Cox proportional hazards model was used to assess the independent efficacy and timing of eribulin monotherapy. The inverse probability of treatment weighting (IPTW) estimate was utilized to compare the EE and LE cohorts.

Results: Of the 507 patients who were initially screened, 226 were included after an intensive chart review: 93, 49, and 84 patients were included in the Non-E, EE, and LE cohorts, respectively. The eribulin cohort showed significantly longer overall survival than the Non-E cohort (30.3 vs. 22.2 months, p = 0.0217). No significant difference was observed in the progression-free survival of the EE and LE cohorts (3.4 vs. 4.4 months, p = 0.1337) after adjusting for clinically relevant factors using IPTW estimates. LE cohort showed good overall survival (OS) compared with patient group of Non-E and EE by log-rank testing (p = 0.0398), although multivariate analysis did not demonstrate eribulin administration timing as an independent prognostic factor of OS. OS was defined from the initiation of first-line chemotherapy date.

Conclusions: Our data provided additional insights regarding the use of eribulin monotherapy as earlier-line chemotherapy. However, the optimal timing of eribulin monotherapy for MBC was not determined in the current study.

Keywords: Eribulin, Metastatic breast cancer, Chemotherapy, First line chemotherapy