eriBULin

General

High Alert Medication: This medication bears a heightened risk of causing significant patient harm when it is used in error.

Pronunciation:
e-rib-yoo-lin


Trade Name(s)

  • Halaven

Ther. Class.

antineoplastics

Pharm. Class.

antimicrotubulars

Indications

  • Metastatic breast cancer that has progressed despite ≥2 previous regimens that included an anthracycline and a taxane in either the adjuvant or metastatic setting.
  • Unresectable or metastatic liposarcoma in patients who have received a prior regimen that included an anthracycline.

Action

Inhibits intracellular microtubule growth phase, causing G2 /M cell-cycle block resulting in apoptotic cell death.

Therapeutic Effect(s):

  • Death of rapidly replicating cells, particularly malignant ones.
  • Improved survival in breast cancer or liposarcoma.

Pharmacokinetics

Absorption: IV administration results in complete bioavailability.

Distribution: Unknown.

Metabolism and Excretion: Minimal metabolism, mostly excreted unchanged in feces (82%) and less in urine (9%).

Half-life: 40 hr.

TIME/ACTION PROFILE (effects on blood counts)

ROUTEONSETPEAKDURATION
IVwithin days7–14 daysup to 2 wk

Contraindication/Precautions

Contraindicated in:

  • Severe hepatic impairment;
  • Severe renal impairment (CCr <15 mL/min);
  • Congenital long QT syndrome;
  • OB:  Pregnancy;
  • Lactation: Lactation.

Use Cautiously in:

  • HF, bradyarrhythmias, concurrent use of drugs known to prolong the QT interval (including Class Ia and III antiarrhythmics), or electrolyte abnormalities (↑ risk of arrhythmias);
  • Moderate renal impairment;
  • Mild or moderate hepatic impairment;
  • Rep:  Women of reproductive potential and men with female partners of reproductive potential;
  • Pedi:  Safety and effectiveness not established in children.

Adverse Reactions/Side Effects

CV: peripheral edema, QT interval prolongation

Derm: alopecia, STEVENS-JOHNSON SYNDROME, TOXIC EPIDERMAL NECROLYSIS, rash

EENT: ↑ lacrimation

F and E: hypokalemia

GI: anorexia, constipation, nausea, abdominal pain, abnormal taste, diarrhea, dry mouth, dyspepsia, mucositis, PANCREATITIS, vomiting

GU: urinary tract infection

Hemat: ANEMIA, NEUTROPENIA

MS: arthralgia, myalgia

Neuro: fatigue, weakness, depression, dizziness, headache, insomnia, peripheral neuropathy

Resp: cough, dyspnea, upper respiratory tract infection

Misc: fever

* CAPITALS indicate life-threatening.
Underline indicate most frequent.

Interactions

Drug-Drug

  • ↑ risk of bone marrow depression with other  antineoplastics  or  radiation therapy.
  • ↓ antibody response and ↑ risk of adverse reactions with  live-virus vaccines.

Route/Dosage

IV (Adults): 1.4 mg/m2  on days 1 and 8 of a 21-day cycle.

Renal Impairment 
IV (Adults): CCr 15–49 mL/min: 1.1 mg/m2  on days 1 and 8 of a 21-day cycle.

Hepatic Impairment 
IV (Adults): Mild hepatic impairment: 1.1 mg/m2  on days 1 and 8 of a 21-day cycle  Moderate hepatic impairment: 0.7 mg/m2  on days 1 and 8 of a 21-day cycle.

Availability (generic available)

Solution for injection: 0.5 mg/mL

Assessment

  • Assess for peripheral motor and sensory neuropathy (numbness, tingling, burning in hands or feet).
  • Monitor ECG periodically as indicated.

Lab Test Considerations:

Monitor CBC prior to each dose; ↑ frequency of monitoring in patients who develop Grade 3 or 4 cytopenias.

  • Monitor electrolytes periodically during therapy.

Implementation

  • Do not confuse eribulin with epirubicin.
  • Correct hypokalemia or hypomagnesemia prior to initiating therapy.

IV Administration

  • Do not administer on Day 1 or Day 8 if:  ANC <1000/mm3 , platelets <75,000/mm3 , or Grade 3 or 4 nonhematological toxicities occur.

  • Day 8 dose may be delayed for a maximum of 1 wk:  If toxicities do not resolve or improve to ≤Grade 2 severity by Day 15, omit dose.

    • If toxicities resolve or improve to ≤Grade 2 by Day 15, administer eribulin at a reduced dose and initiate next cycle no sooner than 2 wk later.
    • If a dose has been delayed for toxicity and toxicities have recovered to Grade 2 severity or less, resume eribulin at a reduced dose of 1.1 mg/m2 .
    • Permanently reduce 1.4 mg/m2  eribulin dose to 1.1 mg/m2  if:  ANC <500/mm3  for >7 days, ANC <1000/mm3  either fever or infection, platelets <25,000/mm3 , platelets <50,000/mm3  requiring transfusion, nonhematologic Grade 3 or 4 toxicities, or omission or delay of Day 8 eribulin dose in previous cycle for toxicity.
    • Permanently reduce 1.4 mg/m2  eribulin dose to 0.7 mg/m2  if:  occurrence of any event requiring permanent dose reduction while receiving 1.1 mg/m2  dose.
    • If occurrence of any event requiring permanent dose reduction while receiving 0.7 mg/m2 :  discontinue eribulin.
  • IV Push:   Dilution:  Administer undiluted or dilute in 100 mL of 0.9% NaCl. Store undiluted in syringe or diluted eribulin for up to 4 hr at room temperature or for up to 24 hr under refrigeration. Discard unused portion of vial.
  • Rate: Infuse over 2–5 min on Days 1 and 8 of a 21-day cycle.
  • Y-Site Incompatibility: Do not dilute in or administer through an IV line containing solutions with dextrose or other medications.

Patient/Family Teaching

  • Advise patient to notify health care professional if fever of ≥100.5°F or other signs or symptoms of infection (chills, cough, burning or pain on urination) or rash occur.
  • Instruct patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and consult health care professional before taking any new medications.
  • Advise patient not to receive vaccinations without consulting health care professional.
  • Rep:  May cause fetal harm. Advise females of reproductive potential to use effective contraception during and for at least 2 wk after last dose of therapy. Advise males with female partners of reproductive potential to use effective contraception for 3.5 mo after final dose. Instruct females of reproductive potential to notify health care professional immediately if pregnancy is planned and to avoid breastfeeding during therapy. May cause male infertility.

Evaluation/Desired Outcomes

Improved survival in breast cancer or liposarcoma.

eriBULinis the Emergency Central Word of the day!