Treatment Name: Eribulin (Halaven®)
How does eribulin work?
Eribulin is designed to stop cancer cells from dividing and cause them to die.
Goals of therapy:
Eribulin is a chemotherapy drug given to alleviate symptoms of metastatic breast cancer and extend life. It is not commonly given with the goal of cure.
- Eribulin intravenous (I.V.) push over 2 to 5 minutes on Day 1 and Day 8 of each treatment cycle
Estimated total infusion time for this treatment:
- Up to 1 hour on each treatment day. Even though eribulin is a short infusion, it may take time for blood lab test results to come back to make sure it is safe to receive the dose
- Infusion times are based on clinical studies, but may vary depending on doctor preference or patient tolerability. Pre-medications and intravenous (I.V.) fluids, such as hydration, may add more time
Eribulin is usually given in an outpatient infusion center, allowing the person to go home afterwards.
Eribulin is repeated every 21 days. This is known as one Cycle. Each cycle is repeated until the drug no longer works or until unacceptable side effects occur.
Click here for common starting dose
In a multi-drug regimen, each medication has unique side effects. When these medicines are given together, drug-related side effects reported in clinical studies give the best estimate of what to expect. In clinical studies, the most commonly reported eribulin side effects are shown here.
In this study, 10% of patients discontinued eribulin due to unacceptable side effects.
How often is monitoring needed?
Labs (blood tests) may be checked before each treatment. Labs often include: Complete Blood Count (CBC), and Comprehensive Metabolic Panel (CMP). Tumor markers such as CEA, CA 15-3, or CA 27.29 may also periodically be checked.
How often is imaging needed?
Imaging may be checked before treatment and every 2 to 4 cycles during treatment. Imaging may include: bone scans and computerized tomography (CT) scans.
How might blood test results/imaging affect treatment?
Depending upon the results, your doctor may advise to continue eribulin as planned, or delay or switch therapy.
- Communicate with your doctor if you are experiencing any early signs of peripheral neuropathy such as "pins and needles" feelings or numbness in your fingers or toes. This is usually reversible if caught early. Your doctor may reduce your dose of eribulin, delay treatment, or stop it all together to minimize this side effect and avoid permanent nerve damage
- You may periodically have an electrocardiogram (ECG or EKG) to assess your hearts’ rhythm and your risk of experiencing a heart rhythm problem known as prolonged QT interval. Eribulin increases your risk of experiencing this heart rhythm problem, as do many other medications. Talk to your doctor or pharmacist to see if any of your other medications can increase your risk. If you are receiving other medications that increase the risk of prolonged QT interval or have a history of heart failure, you may receive electrocardiograms more often while receiving eribulin
- To reduce time at the infusion center, ask your doctor if you can blood lab tests done the day before treatment. This may save time on the day of treatment
- A pharmacist should ALWAYS review your medication list to ensure that drug interactions are prevented or managed appropriately
- Clinical trials may exist for breast cancer. Ask your doctor if any studies are currently enrolling in your area. If not, go to clinicaltrials.gov to search for other centers offering study medications
Patient Assistance & Co-payment Coverage
Patients under the age of 65 years, or those with private insurance plans:
If you have insurance and are looking for patient assistance or copay assistance for Eribulin (Halaven®), we have provided links that may help.
Visit our Patient Assistance page and click the links to various patient assistance programs for help paying for Eribulin (Halaven®). Depending upon your income, they may be able to help cover the cost of:
For Branded medications (may be available for generic medications too), check with the manufacturer to determine if a co-pay card is offered and if it could reduce your monthly copay.
- If you are uninsured, check with the manufacturer to determine if you are eligible to receive medication at no cost.
Medicare and Medicaid patients (Patients 65 years or older):
The clinic providing treatment will likely pre-authorize medications and immune therapies such as Eribulin (Halaven®) and are the best source to help you understand drug cost.
- Ask to speak with a patient assistance technician or financial counselor at the clinic or hospital administering this therapy.
What is Emotional Wellness?
Emotional wellness is having a positive outlook balanced with a realistic understanding of current life events. This requires both an awareness and acceptance of your emotions. It is with this knowledge that you can develop a plan to take the necessary actions to positively impact your life.
Emotional wellness uses an ongoing process to continually reflect on the stressors of life in a constructive manner to move forward and create happiness.
Because emotional wellness is deeply connected with physical, social, and spiritual wellness, pursuing it often becomes particularly difficult in times of major illness. Despite this difficulty, working toward emotional wellness has been connected to improved treatment outcomes and a higher likelihood of achieving goals of therapy.
Learn more about pursuing emotional wellness while receiving treatment with Eribulin (Halaven®)
What is Breast Cancer - metastatic?
What is Metastatic Breast Cancer?
A disease of the milk-producing glands known as lobules, milk ducts, or other cells found in the breast. Metastatic breast cancer is one that has moved from the breast to other areas of the body, which may include the brain, liver, or bone. Breast cancer is one of the most common types of cancers in women, but may rarely affect men as well. Known causes of breast cancer include genetic causes, such as the BRCA mutation, or obesity. The effectiveness of the treatment may depend upon the stage at diagnosis.
Types of metastatic breast cancer:
1. Hormone-receptor positive or negative (60 - 65% of patients)
- Estrogen Receptor positive (ER)+ or negative (ER)-
- Progestin Receptor positive (PR)+ or negative (PR)-
2. Hormone Epidermal growth factor Receptor-2 (HER-2) positive or negative (20 - 25% of patients)
3. Triple Negative (15 - 18% of patients)
NOTE: Treatment Options listed below are not all-inclusive. Other treatments may be available. ChemoExperts provides drug information and does not recommend any one treatment over another. Only your Doctor can choose which therapy is appropriate for you.
If you are interested in reading the clinical trials results, please click on references below:
Cortes J, O’Shaughnessy J, Loesch D, et al. Eribulin monotherapy versus treatment of physician’s choice in patients with metastatic breast cancer (EMBRACE): a phase 3 open-label randomised study. Lancet 2011;377:914-923.
Tumor markers or Biomarkers
Carcinoembryonic antigen (CEA), Cancer Antigen 15-3 (CA 15-3), and Cancer Antigen 27.29 (CA 27.29) are biomarkers that are often found and measured in the blood of people diagnosed with breast cancer. Doctors will commonly measure these biomarkers to see how well a treatment is working.
Common Starting Dose
Eribulin 1.4 mg/m2 I.V. push over 5 to 10 minutes on Day 1 and Day 8 of a 21-day cycle
What is a CBC?
A Complete Blood Count (CBC) is a frequently ordered blood test that tells clinicians the status of your: 1) White blood cell count, 2) Hemoglobin, and 3) Platelet count at the time the test was taken.
1) White blood cell count (WBC): is used to determine infection risk, or response to chemotherapy. Certain chemotherapy agents may harm our good infection-fighting cells. Sometimes chemotherapy may need to be delayed to allow these cells to recover.
2) Hemoglobin: is used to determine if someone is anemic. Anytime the hemoglobin is below 12 g/dL, the person is said to be anemic. Red blood cell transfusions, and sometimes iron can be given to restore the hemoglobin level, but anemia treatment should always aim at treating the underlying cause or condition.
3) Platelet count: is used to determine if the risk of bleeding is increased or if a platelet transfusion is required to prevent bleeding. Certain medications that increase bleeding risk, such as: aspirin, certain chemotherapy agents, and blood thinners, may need to be stopped temporarily until the platelet count is within a safe range.
What is a CMP?
A Comprehensive Metabolic Panel (CMP) is a frequently ordered blood test that tells clinicians the status of your: 1) Electrolytes & Acid/Base status, 2) Kidney function, 3) Liver function, 4) Blood sugar, and 5) Calcium at the time the test was taken. It is commonly used to monitor liver and kidney function when beginning new medications such as chemotherapy. A total of 14 tests are run simultaneously and are shown below.
Electrolytes & Acid/Base status:
1) Sodium, 2) Potassium, 3) Carbon dioxide, 4) Chloride
5) BUN (blood urea nitrogen), 6) Serum creatinine (Scr)
7) AST, 8) ALT, 9) Total bilirubin, 10) Alk Phos, 11) Albumin, 12) Total protein
13) Serum glucose
14) Serum calcium
What does Cure mean?The word “cure” means there are no cancer cells left in the body and cancer will never come back. Depending on the cancer type and stage, this may be the true goal of therapy. However, it is very difficult to prove all cancer cells are gone. Even though images, like X-rays and MRI’s, and blood tests may not show any signs of cancer, there can be a small amount of cancer cells still left in the body. Because of this, the word “remission” is used more often. This means there are no signs or symptoms of cancer. Patients in remission are followed closely for any signs of cancer returning. Sometimes, more chemotherapy may be given while in remission to prevent the cancer from coming back.
Doctors usually do not consider a patient “cured” until the chance of cancer returning is extremely low. If cancer does return, it usually happens within 5 years of having a remission. Because of this, doctors do not consider a patient cured unless the cancer has not come back within 5 years of remission. The five-year cutoff does not apply to all cancers.