Antrasiklin ve taksan rezistant metastatik meme kanseri tedavisinde eribulin mesilat etkinlik ve tolerabilitesi. Tek merkez deneyimi.

Year 2019, , 10 - 14, 31.03.2019

Çağlayan Geredeli

https://doi.org/10.21601/ortadogutipdergisi.409706

Abstract

Amaç: Mikrotübül
inhibitörü olan eribulin mesilat antrasiklin ve taksana rezistant metastatik
meme kanserli hastalarda kullanımı kabul edilmiştir. Amaç eribulin mesilatın
etkinliğini araştırmak.
Gereç ve Yöntemler: Retrospektif
çalışmada İstanbul Okmeydanı eğitim ve araştırma hastanesi tıbbi onkoloji
kliniğinde metastatik meme kanseri nedeniyle tedavi görmekte olan ve öncesinde
antrasiklin ve taksan dahil olmak üzere en az 2 seri kemoterapi almış olan
hastalar alındı.
Bulgular: Çalışmaya toplam 25 hasta
alındı. Median yaş 54,9 (range 36-73) idi. median takip süresi 11.6 aydı.
Hastaların %68 ER pozitif, %68 Pr pozitif, %8,3 HER2 pozitif ve %6,2 triple
negatifti. Hastalardan %78 inde karaciğer, %64 ünde kemik,%36sında akciğer
metastazı mevcuttu. Eribuli seri sayısı 4,4 (min3-max6) idi. Eribulin kür
sayısı 6,6 (min 1-max 33) idi. Median PFS 6,6 (0-26) ay olup median OS 17
(0-30) aydı. %8 inde tam yanıt (2 hasta), %12 (3hasta) sinde parsiyel yanıt,%52
(13 hasta) stabil yanıt ve %28 (7 hasta ) progresif hastalık mevcuttu. Hastaların
hormon reseptör durumu ve HER2 durumuna göre sağ kalımda farklılık yoktu(P=0,187).
Hastalardaki metastaz bölgelerine göre de sağ kalım da farklılık tespit
edilmedi(P=0,875). %12 (3 hasta ) hastada grade 3-4 hematolojik toksisite ve
%4( 1 hasta )hastada grade 3-4 nöropati görülmüşken %40 (10 hasta ) hastada
grade 1-2 hematolojik toksisite, %24 (6hasta ) hastada grade 1-2 nöropati
görülmüştür.
Sonuç: Eribulin mesilat antrasiklin
ve taksan rezistans önceden çoklu seri kemoterapi almış metastatik meme kanserli
hastaların tedavisinde 3. Seri ve daha sonraki serilerde etkin ve tolerabl
bulunmuştur.

Keywords

metastatik meme kanseri, kemoterapi, eribulin mesilat

Efficacy and tolerability of eribulin mesylate in the treatment of anthracycline and taksan resistance to metastatic breast cancer. Single central experience

Abstract

Aim: The
microtubule inhibitor eribulin mesylate anthracycline and taxane resistance
have been accepted for use in patients with metastatic breast cancer. The goal
is to investigate the efficacy of eribulin mesylate.

Material
and Methods: Retrospective study was carried out in Istanbul
Okmeydanı educational and research hospital medical oncology clinic patients
who were treated for metastatic breast cancer and who had received at least 2
serial chemotherapy including anthracycline and taksan.
Results: A total of 25 patients were
included in the study. Median age was 54.9 (range 36-73). Median follow-up time
is 11.6 months. 68% of the patients were ER positive, 68% were Pr positive,
8.3% were HER2 positive and 6.2% were triple negative. 78% of the patients had
liver, 64% had bone, and 36% had lung metastases. The treatement line number
was 4.4 (min3-max6). The number of cycles of Eribulin was 6.6 (min 1-max 33).
Median PFS is 6.6 (0-26) months and median OS is 17 (0-30). There were 8%
complete response (2 patients), 12% (3 patients) partial response, 52% (13
patients) stable response and 28% (7 patients) progressive disease. there was no
difference in survival according to patients' hormone receptor status and HER2
status (P = 0.187). There was no difference in survival according to the
metastatic sites in the patients (P = 0.875). Grade 3 to 4 hematologic toxicity
in 12% (3 patients) and grade 3-4 neuropathy in 4% (1 patient) in the
patient,40% (10 patients) grade 1-2 hematologic toxicity in the patient, grade 1-2
neuropathies were seen
 Conclusion: Eribulin mesylate have been
found to be effective and tolerable in line 3 and more than subsequent line in
the treatment of patients with metastatic breast cancer who anthracycline and
taksan resistance and previously received multiple line chemotherapy.

Keywords

metastatic breast cancer, chemotherapy, eribulin mesylate

References

• 1. Torre LA, Bray F, Siegel RL, Ferlay J, Lortet-Tieulent J, Jemal A. Global cancer statistics, 2012. CA Cancer J Clin 2015; 65: 87–108
• 2. Globocan 2012 istatistikleri. http://globocan.iarc.fr/old/FactSheets/cancers/breast-new.asp
• 3. National Comprehensive Cancer Network . NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines)®: Breast Cancer Version 1.2014. Fort Washington, PA: National Comprehensive Cancer Network; 2014.
• 4. Cardoso F, Costa A, Senkus E et al. 3rd ESO-ESMO ınternational consensus guidelines for advanced breast cancer (ABC 3). Ann Oncol 2017; 28: 3111
• 5. Baselga J, Cortés J, Kim S-B et al. Pertuzumab plus trastuzumab plus docetaxel for metastatic breast cancer. N Engl J Med 2012; 366: 109–19.
• 6. Geyer CE, Forster J, Lindquist D et al. Lapatinib plus capecitabine for HER2-positive advanced breast cancer. N Engl J Med 2006; 355: 2733–43.
• 7. Slamon DJ, Leyland-Jones B, Shak S et al. Use of chemotherapy plus a monoclonal antibody against HER2 for metastatic breast cancer that overexpresses HER2. N Engl J Med 2001; 344: 783–92.
• 8. Verma S, Miles D, Gianni L et al. Trastuzumab emtansine for HER2-positive advanced breast cancer. N Engl J Med 2012; 367: 1783–91.
• 9. Baselga J, Campone M, Piccart M et al. Everolimus in postmenopausal hormone-receptor-positive advanced breast cancer. N Engl J Med 2012; 366: 520–29.
• 10. Cristofanilli M, Turner NC, Bondarenko I et al. Fulvestrant plus palbociclib versus fulvestrant plus placebo for treatment of hormone-receptor positive, HER2-negative metastatic breast cancer that progressed on previous endocrine therapy (PALOMA-3): final analysis of the multicentre, double-blind, phase 3 randomised controlled trial. Lancet Oncol. 2016; 17: 425-39.
• 11. Finn RS, Crown JP, Lang I et al. The cyclin dependent kinase 4/6 inhibitor palbociclib in combination with letrozole versus letrozole alone as first-line treatment of oestrogen receptor-positive, HER2-negative, advanced breast cancer (PALOMA-1/TRIO-18): a randomised phase 2 study. Lancet Onco. 2015; 16 :25–35.
• 12. Hortobagyi GN, Stemmer SM, Burris HA et al. Ribociclib as First-Line Therapy for HR-Positive, Advanced Breast Cancer. N Engl J Med 2016; 375: 1738-48.
• 13. Twelves C, Jove M, Gombos A, Awada A. Cytotoxic chemotherapy: Still the mainstay of clinical practice for all subtypes metastatic breast cancer. Crit Rev Oncol Hematol 2016; 100: 74–87.
• 14. Jimeno A. Eribulin: rediscovering tubulin as an anticancer target. Clin Cancer Res 2009; 15: 3903–5.
• 15. McBride A, Butler SK. Eribulin mesylate: a novel halichondrin B analogue for the treatment of metastatic breast cancer. Am J Health-Syst Pharm 2012; 69: 745–55.
• 16. 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: 914–23.
• 17. Kaufman PA, Awada A, Twelves C et al. Phase III open-label randomized study of eribulin mesylate versus capecitabine in patients with locally advanced or metastatic breast cancer previously treated with an anthracycline and a taxane. J Clin Oncol 2015; 33: 594–601.
• 18. Blum JL, Jones SE, Buzdar AU, et al. Multicenter phase II study of capecitabine in paclitaxel-refractory metastatic breast cancer. J Clin Oncol 1999; 17: 485–93.
• 19. Reichardt P, von Minckwitz G, Luck HJ et al. Capecitabine: the new standard in metastatic breast cancer failing anthracycline- and taxane-containing chemotherapy? Mature results of a large multicenter phase II trial. Eur J Cancer 2001; 37: 191.
• 20. Fumoleau P, Largillier R, Trillet-Lenoir V et al. Capecitabine (Xeloda) in patients with advanced breast cancer (ABC), previously treated with anthracyclines and taxanes: a large phase II study. Proc Am Soc Clin Oncol 2002; 21: 62.
• 21. Livingston RB, Ellis GK, Gralow JR et al. Dose-intensive vinorelbine with concurrent granulocyte colony-stimulating factor support in paclitaxel-refractory metastatic breast cancer. J Clin Oncol 1997; 15: 1395–400.
• 22. Zelek L, Barthier S, Delford JP et al. Weekly vinorelbine is an effective palliative regimen after failure with anthracyclines and taxanes in metastatic breast cancer carcinoma. Cancer 2001; 92: 2267–72.
• 23. Chaudhry S, Abdel-Rahman HA, Patil R et al. Prospective phase II study of weekly cisplatin-gemcitabine in refractory metastatic breast cancer (RM-BC). Proc Am Soc Clin Oncol 2000; 19: 111.
• 24. Valenza R, Leonardi V, Gebbia V, Agostara B. Gemcitabine and vinorelbine in pretreated advanced breast cancer: a pilot study. Ann Oncol 2000; 11: 495–96.