ONCAlert | 2017 San Antonio Breast Cancer Symposium
Breast Cancer Case Studies

Joyce O'Shaughnessy, MD: Candidacy for Eribulin Therapy

Joyce O'Shaughnessy, MD
Published Online:Apr 01, 2016
Connie C is a 56-year-old with no chronic conditions. In September of 2014, after presenting to her PCP with a palpable breast mass and fatigue of several months' duration she underwent a left mammogram revealing a large breast mass.

Triple Negative Breast Cancer with Andrew Seidman, MD and Joyce O'Shaughnessy, MD: Case 2



What are the main characteristics of this patient that make her an appropriate candidate for eribulin therapy?

Metastatic breast cancer patients such as this patient, when we’re thinking about treatment options, we’d like to offer eribulin to patients that came as close to the clinical trial setting that led to the definitive data. In this case that is improvement of overall survival, and that clinical trial was the EMBRACE trial. Those patients had been treated with an anthracycline and a taxane, and had received at least two prior regimens for metastatic breast cancer.

This patient fits the eribulin scenario perfectly in that regard, so she would be expected to have a good chance of having improvement in her survival. There was another trial where eribulin was moved into the second-line setting and was compared against capecitabine, and it had a nice survival advantage in the triple negative population.

Triple Negative Breast Cancer: Case 2

Connie C is a 56-year-old television producer for a local news station, her medical history is unremarkable for any chronic conditions.

In September of 2014, after presenting to her PCP with a palpable breast mass and fatigue of several months’ duration she underwent a left mammogram revealing a large breast mass.

  • A CT scan of the chest/abdomen/pelvis showed a large primary mass in the left breast, multiple enlarged mediastinal lymph nodes, and several hepatic lesions consistent with metastases
  • Breast and liver biopsies showed poorly differentiated, mammary adenocarcinoma that was ER-, PgR- and HER2- (triple-negative) with Ki67 staining 70%
  • She began first-line chemotherapy with doxorubicin

In February of 2015, she returns with increasing fatigue and back pain; her CT scan shows progression of the hepatic lesions, and bone scan shows new lesions in the T4 and T5 vertebra. At the time of progression, her ECOG performance status (PS) is 1.

  • She began therapy with docetaxel plus capecitabine as part of a clinical trial and her disease stabilized after 5 cycles

In June of 2015, she returns for follow up with worsening back pain and intermittent dyspnea. Her CT scan at the time of progression shows the bone lesions worsening and several new bilateral pulmonary lesions.

  • Patient remains active, with good liver and renal function; her ECOG PS remains at 1
  • The oncologist initiates therapy with eribulin at a dose of 1.4 mg/m2; she tolerates the therapy well and shows a partial response after 5 cycles, with improvement of the bone and pulmonary lesions, and stable hepatic disease
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