Review on the clinical use of eribulin mesylate for the treatment of breast cancer.

INTRODUCTION: Breast cancer is the second leading cause of cancer death among women and the median survival of metastatic breast cancer (MBC) has remained, for many decades, at two to three years after diagnosis. Eribulin mesylate is a nontaxane inhibitor of microtubule dynamics and the only cytotoxic agent in the last decade to improve overall survival in heavily pretreated patients with MBC. Eribulin was approved for the treatment of MBC in 2010 by the FDA in patients that received at least two prior chemotherapy regimens and as second-line treatment in 2011 by EMA. In both cases prior therapy should have included an anthracycline and a taxane in either the adjuvant or metastatic setting. AREAS COVERED: This manuscript reviews the current available data on the use of this important cytotoxic agent including its pharmacology, pharmacokinetics, clinical efficacy, safety, and potential economic factors as well as ongoing clinical trials and main areas of research. EXPERT OPINION: Eribulin mesylate is a novel microtubule dynamics inhibitor compound important for the management of MBC and can be used for the treatment of patients who have previously received one/two chemotherapeutic regimens for metastatic disease and whose prior therapy included an anthracycline and a taxane. It's toxicity profile is acceptable and presents several favorable features namely a low probability of drug-drug interactions in the clinical setting, easy administration as bolus, low hypersensitivity chances and full tolerability in renal dysfunction patients. Eribulin is currently being evaluated as first-line treatment for MBC, in the adjuvant/neoadjuvant setting alone and in combination with a variety of agents, particularly biologic treatments. Future research is needed to optimize the role of eribulin in the treatment of MBC.