eribulin mesylate: clinical use

Prescribing considerations

• Restrict prescribing and administration to clinicians experienced in anticancer therapy and staff trained in cytotoxic handling.
• Consider hepatic and renal function because impairment can increase exposure.
• Assess pre-existing neuropathy, active infection, cardiac disease, bradyarrhythmia and concomitant QT-prolonging treatment.
• Discuss fertility preservation where relevant; irreversible male infertility is possible.

Contraindications and cautions

• Hypersensitivity to eribulin or any excipient.
• Breastfeeding.
• Avoid in congenital long-QT syndrome; this is a precaution rather than a formal contraindication.

Monitoring

• Full blood count, with particular attention to neutrophils and platelets.
• Clinical assessment for infection, febrile neutropenia and bleeding.
• Peripheral sensory and motor neuropathy.
• Liver and renal function.
• Potassium, calcium and magnesium; correct deficiencies and monitor periodically.
• ECG where cardiac disease, bradyarrhythmia, QT-prolonging medicines or relevant electrolyte abnormalities are present.

Clinical pharmacology

Eribulin is a synthetic halichondrin-class microtubule inhibitor. It blocks microtubule growth, causes mitotic arrest and promotes apoptotic cell death. Distribution is rapid followed by prolonged elimination. Unchanged eribulin predominates, with biliary excretion more important than renal clearance.

Formulation and product differences

• The selected product is a ready-to-use, clear, colourless aqueous solution in a glass vial.
• It contains ethanol and water for injections, with acid or alkali used for pH adjustment.
• It may be diluted with sodium chloride solution but not glucose solution.
• It is cytotoxic; trained staff should use appropriate protective equipment, and pregnant staff should not handle it.

Injection

Route: Parenteral

Strengths: 0.44 mg/mL