Eribulin Disease Interactions

Because of their cytotoxic effects on rapidly proliferating tissues, antineoplastic agents frequently can, to varying extent, induce myelosuppression. The use of these drugs may be contraindicated in patients with known infectious diseases. All patients should be instructed to immediately report any signs or symptoms suggesting infection such as fever, sore throat, or local infection during antineoplastic therapy. Close clinical monitoring of hematopoietic function is recommended.

Adverse hematologic effects including neutropenia, and febrile neutropenia (fever >=38.5°C with Grade 3 or 4 neutropenia) have been associated with the use of eribulin. It is recommended to monitor complete blood counts prior to each dose and increase the frequency of monitoring in patients who develop Grade 3 or 4 cytopenias. Delay administration of therapy and reduce subsequent doses in patients who experience febrile neutropenia or Grade 4 neutropenia lasting longer than 7 days. Do not administer therapy on Day 1 or Day 8 if ANC < 1,000/mm3, platelets < 75,000/mm3, or grade 3 or 4 non-hematological toxicities.

Pharmacokinetics studies to evaluate the effect of hepatic impairment in patients treated with eribulin demonstrated that patients with mild hepatic impairment (Child-Pugh A) and moderate hepatic impairment (Child-Pugh B) had higher eribulin exposures as compared to patients with normal hepatic function. It is recommended to reduce the starting dose of eribulin in patients with mild or moderate hepatic impairment according to the manufacturer recommendations. Eribulin has not been studied in patients with severe hepatic impairment (Child-Pugh C). Caution and close monitoring should be taken.

In clinical trials, eribulin caused peripheral neuropathy. Monitor patients closely for signs of peripheral motor and sensory neuropathy. It is recommended to withhold treatment in patients who experience Grade 3 or 4 peripheral neuropathy, until resolution to Grade 2 or less.

In clinical trials, eribulin has caused QT prolongation independent of concentration. Close monitoring should be exercised in patients with congestive heart failure, bradyarrhythmias, those taking drugs known to prolong the QT interval, including Class Ia and III antiarrhythmics, and electrolyte abnormalities. It is recommended to correct hypokalemia or hypomagnesemia prior to starting therapy and monitor these electrolytes periodically during therapy. Avoid in patients with congenital long QT syndrome.

Pharmacokinetics studies to evaluate the effect of renal impairment in patients treated with eribulin demonstrated that patients with moderate and severe renal impairment had higher eribulin dose-normalized exposures compared to that in patients with normal renal function. It is recommended to reduce the starting dose of eribulin in patients with moderate or severe renal impairment (CrCL 15-49 mL/min) according to the manufacturer recommendations.