What are the main indications for dose reduction with eribulin?
When I consider dose reducing eribulin, the reasons that most commonly are encountered are myelosuppression, so a low neutrophil count on the day of treatment, which can also be addressed by the insertion of growth factors, such as G-CSF, Neupogen, or Neulasta. So that's not always a reason for dose reduction.
For me, more commonly the reason for dose reduction is either peripheral neuropathy, which was the most common reason for dose reduction in the randomized trial, but also fatigue. Fatigue is a very difficult symptom to tease out in a population of metastatic breast cancer patients receiving their third line of chemotherapy.
Triple Negative Breast Cancer: Case 1
Christine H is a 54-year-old stay-at-home-mother who works part time as a real estate agent. Medical history is notable for hypertension (well controlled) and surgery for aortic aneurysm in 2011
In September 2013, she presented to her PCP with a right breast lump; mammogram showed a large primary breast mass and two enlarged axillary lymph nodes.
At her follow-up in May 2014, the patient showed progression of the right chest wall metastases, and several new liver lesions were detected.
In December of 2014, she presented with increasing fatigue and chest pain on follow up and her CT scan was consistent with progression of the hepatic metastases, with several new lesions also noted in the lungs; her ECOG performance status (PS) at the time was 1.