Eribulin

How it works

It binds tubulin and inhibits microtubule growth without affecting shortening, sequestering tubulin into non-productive aggregates and arresting cells at the G2/M phase, triggering apoptosis.

Prescribing in practice

• Myelosuppression, particularly neutropenia, is dose-limiting and can be severe; a full blood count must be checked before each dose and treatment delayed or reduced for cytopenias.
• Prescribe and administer only under specialist oncology supervision as an intravenous infusion, with dose modification for hepatic and renal impairment.
• It can cause peripheral neuropathy and QT-interval prolongation, so caution is needed with other QT-prolonging drugs and electrolyte disturbance.

Monitoring

Monitor full blood count before each cycle, alongside peripheral neuropathy, ECG/QT and electrolytes where indicated.

Counselling the patient

• Report fever, sore throat or other signs of infection without delay, as your white cells may be low.
• Tell your team about numbness, tingling or weakness in the hands or feet.
• Effective contraception is required during and for a period after treatment.

Evidence & guidelines

The EMBRACE trial demonstrated an overall survival benefit for eribulin in heavily pre-treated metastatic breast cancer, and its use is informed by NICE technology appraisal guidance.