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METASTATIC BREAST CANCERADVANCED LIPOSARCOMA
Important Safety Information
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Full Prescribing Information
Metastatic Breast
Cancer
Advanced
Liposarcoma

The dual action of HALAVEN®

View the mechanism of action video for HALAVEN, the first agent in the halichondrin class.1

Preclinical studies have demonstrated the ability of HALAVEN to

Induce tumor cell death*

With its distinct binding profile, HALAVEN causes irreversible mitotic blockage resulting in apoptosis, leading to the destruction of many tumor cells.2-5

*Preclinical evidence does not imply clinical efficacy.

HALAVEN binds with high affinity to the growing plus ends of microtubules

HALAVEN binds with high affinity to the growing plus ends of microtubules.6

  • Microtubule growth occurs primarily at these plus ends4

HALAVEN sequesters tubulin into nonproductive aggregates, preventing participation in microtubule assembly

HALAVEN sequesters tubulin into nonproductive aggregates, preventing participation in microtubule assembly.2,4,5

  • Microtubules are a key part of the cell-division process, allowing tumor growth7

HALAVEN inhibits microtubule growth and prevents normal mitotic spindle formation

HALAVEN inhibits microtubule growth and prevents normal mitotic spindle formation.2,4

  • Disruption of microtubule function results in mitotic blockage, leading to tumor cell death by apoptosis4

HALAVEN induces apoptosis and may impact the residual tumor cells2,8

Alter the tumor microenvironment*†

By promoting the epithelial phenotype, HALAVEN reduces the migration and invasive capacity of tumor cells.2,8,9

*Preclinical evidence does not imply clinical efficacy.

†Based on preclinical studies, including human breast cancer models (in vitro/in vivo).

 
HALAVEN induces vascular remodeling, increasing oxygen flow to the tumor

HALAVEN induces vascular remodeling, increasing oxygen flow to the tumor.2,9

  • Abnormal vasculature causes irregular blood flow throughout the tumor, resulting in hypoxic regions10

HALAVEN reduces the hypoxic conditions associated with an abnormal tumor microenvironment

HALAVEN reduces the hypoxic conditions associated with an abnormal tumor microenvironment.2,9

  • Hypoxic conditions lead to phenotypic changes that cause increased migration and invasive capacity of the tumor cells10,11

HALAVEN opposes the mesenchymal phenotype and promotes the epithelial phenotype

HALAVEN opposes the mesenchymal phenotype and promotes the epithelial phenotype.2,8

  • The mesenchymal phenotype correlates with increased migration and invasiveness of tumor cells8

HALAVEN makes residual tumor cells into ones that are less prone to migrate and invade2

Indications

Metastatic Breast Cancer

HALAVEN (eribulin mesylate) Injection is indicated for the treatment of patients with metastatic breast cancer (mBC) who have previously received at least 2 chemotherapeutic regimens for the treatment of metastatic disease. Prior therapy should have included an anthracycline and a taxane in either the adjuvant or metastatic setting.

Liposarcoma

HALAVEN is indicated for the treatment of patients with unresectable or metastatic liposarcoma who have received a prior anthracycline-containing regimen.

Important Safety Information

Warnings and Precautions

Neutropenia: Severe neutropenia (ANC <500/mm3) lasting >1 week occurred in 12% of patients with mBC and liposarcoma or leiomyosarcoma. Febrile neutropenia occurred in 5% of patients with mBC and 2 patients (0.4%) died from complications. Febrile neutropenia occurred in 0.9% of patients with liposarcoma or leiomyosarcoma, and fatal neutropenic sepsis occurred in 0.9% of patients. Patients with mBC with elevated liver enzymes >3 × ULN and bilirubin >1.5 × ULN experienced a higher incidence of Grade 4 neutropenia and febrile neutropenia than patients with normal levels. Monitor complete blood cell counts prior to each dose, and increase the frequency of monitoring in patients who develop Grade 3 or 4 cytopenias. Delay administration and reduce subsequent doses in patients who experience febrile neutropenia or Grade 4 neutropenia lasting >7 days.

Peripheral Neuropathy: Grade 3 peripheral neuropathy occurred in 8% of patients with mBC (Grade 4=0.4%) and 22% developed a new or worsening neuropathy that had not recovered within a median follow-up duration of 269 days (range 25-662 days). Neuropathy lasting >1 year occurred in 5% of patients with mBC. Grade 3 peripheral neuropathy occurred in 3.1% of patients with liposarcoma and leiomyosarcoma receiving HALAVEN and neuropathy lasting more than 60 days occurred in 58% (38/65) of patients who had neuropathy at the last treatment visit. Patients should be monitored for signs of peripheral motor and sensory neuropathy. Withhold HALAVEN in patients who experience Grade 3 or 4 peripheral neuropathy until resolution to Grade 2 or less.

Embryo-Fetal Toxicity: HALAVEN can cause fetal harm when administered to a pregnant woman. Advise females of reproductive potential to use effective contraception during treatment with HALAVEN and for at least 2 weeks following the final dose. Advise males with female partners of reproductive potential to use effective contraception during treatment with HALAVEN and for 3.5 months following the final dose.

QT Prolongation: Monitor for prolonged QT intervals in patients with congestive heart failure, bradyarrhythmias, drugs known to prolong the QT interval, and electrolyte abnormalities. Correct hypokalemia or hypomagnesemia prior to initiating HALAVEN and monitor these electrolytes periodically during therapy. Avoid in patients with congenital long QT syndrome.

Adverse Reactions

In patients with mBC receiving HALAVEN, the most common adverse reactions (≥25%) were neutropenia (82%), anemia (58%), asthenia/fatigue (54%), alopecia (45%), peripheral neuropathy (35%), nausea (35%), and constipation (25%). Febrile neutropenia (4%) and neutropenia (2%) were the most common serious adverse reactions. The most common adverse reaction resulting in discontinuation was peripheral neuropathy (5%).

In patients with liposarcoma and leiomyosarcoma receiving HALAVEN, the most common adverse reactions (≥25%) reported in patients receiving HALAVEN were fatigue (62%), nausea (41%), alopecia (35%), constipation (32%), peripheral neuropathy (29%), abdominal pain (29%), and pyrexia (28%). The most common (≥5%) Grade 3-4 laboratory abnormalities reported in patients receiving HALAVEN were neutropenia (32%), hypokalemia (5.4%), and hypocalcemia (5%). Neutropenia (4.9%) and pyrexia (4.5%) were the most common serious adverse reactions. The most common adverse reactions resulting in discontinuation were fatigue and thrombocytopenia (0.9% each).

Use in Specific Populations

Lactation: Because of the potential for serious adverse reactions in breastfed infants from eribulin mesylate, advise women not to breastfeed during treatment with HALAVEN and for 2 weeks after the final dose.

Hepatic and Renal Impairment: A reduction in starting dose is recommended for patients with mild or moderate hepatic impairment and/or moderate or severe renal impairment.

 

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References: 1. Towle MJ, Salvato KA, Budrow J, et al. In vitro and in vivo anticancer activities of synthetic macrocyclic ketone analogues of halichondrin B. Cancer Res. 2001;61(3):1013-1021. 2. HALAVEN [package insert]. Woodcliff Lake, NJ: Eisai Inc. 3. Towle MJ, Salvato KA, Wels BF, et al. Eribulin induces irreversible mitotic blockade: implications of cell-based pharmacodynamics for in vivo efficacy under intermittent dosing conditions. Cancer Res. 2011;71(2):496-505. 4. Jordan MA, Kamath K, Manna T, et al. The primary antimitotic mechanism of action of the synthetic halichondrin E7389 is suppression of microtubule growth. Mol Cancer Ther. 2005;4(7):1086-1095. 5. Kuznetsov G, Towle MJ, Cheng H, et al. Induction of morphological and biochemical apoptosis following prolonged mitotic blockage by halichondrin B macrocyclic ketone analog E7389. Cancer Res. 2004;64(16):5760-5766. 6. Smith JA, Wilson L, Azarenko O, et al. Eribulin binds at microtubule ends to a single site on tubulin to suppress dynamic instability. Biochemistry. 2010;49(6):1331-1337. 7. Jordan MA, Wilson L. Microtubules as a target for anticancer drugs. Nat Rev Cancer. 2004;4(4):253-265. 8. Yoshida T, Ozawa Y, Kimura T, et al. Eribulin mesilate suppresses experimental metastasis of breast cancer cells by reversing phenotype from epithelial–mesenchymal transition (EMT) to mesenchymal–epithelial transition (MET) states. Br J Cancer. 2014;110(6):1497-1505. 9. Funahashi Y, Okamoto K, Adachi Y, et al. Eribulin mesylate reduces tumor microenvironment abnormality by vascular remodeling in preclinical human breast cancer models. Cancer Sci. 2014;105(10):1334-1342. 10. Dybdal-Hargreaves NF, Risinger AL, Mooberry SL. Eribulin mesylate: mechanism of action of a unique microtubule-targeting agent. Clin Cancer Res. 2015;21(11):2445-2452. 11. Jiang J, Tang YL, Liang XH. EMT: a new vision of hypoxia promoting cancer progression. Cancer Biol Ther. 2011;11(8):714-723.