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Eribulin mesylate (Halaven)

This page tells you about the chemotherapy drug eribulin and its possible side effects. There is information about

 

What eribulin is

Eribulin is a chemotherapy drug used to treat advanced breast cancer. It is usually used for people who have already had at least two other courses of chemotherapy. Researchers are also looking at eribulin in trials for other cancer types.

Eribulin is also called Halaven and its full name is eribulin mesylate. It was originally developed from a sea sponge called Halichondria okadai but is now made in the laboratory.

Eribulin works by stopping (inhibiting) the cancer cells from separating into two new cells. So it blocks the growth of the cancer. It is a type of drug called a microtubule inhibitor.

 

How you have eribulin

You have eribulin into your bloodstream (intravenously). You can have it through a thin, short tube (a cannula) put into a vein in your arm each time you have treatment. Or you may have it through a central line, a portacath or a PICC line. These are long, plastic tubes that give the drugs directly into a large vein in your chest. You have the tube put in just before your course of treatment starts and it stays in place as long as you need it.

You usually have chemotherapy as a course of several cycles of treatment. Each cycle of eribulin treatment lasts 3 weeks. 

  • You have eribulin on the first day
  • You have a second dose a week later
  • You then have no treatment for two weeks

Your next cycle of treatment starts 3 weeks after the first dose of eribulin

The side effects associated with eribulin are listed below. You can use the links to find out more about each side effect. For general information, see our cancer drug side effects section.

 

Common side effects

More than 10 in every 100 people have one or more of the side effects listed below.

A temporary drop in the number of blood cells made by the bone marrow, causing

  • Increased risk of getting an infection from a drop in white blood cells – it is harder to fight infections and you can become very ill. You may have headaches, aching muscles, a cough, sore throat, pain passing urine or feel cold and shivery
  • Tiredness and breathlessness due to a drop in red blood cells (anaemia) – you may need a blood transfusion

Some of these side effects can be life threatening, particularly infections. You should contact your doctor if you have any of these effects. Your doctor will check your blood counts regularly to see how well your bone marrow is working.

Other common side effects include

  • Tiredness (fatigue) and muscle weakness during and after treatment in half of the people (50%) having eribulin
  • Hair thinning in about half of people (50%) but hair grows back once the treatment ends
  • Loss of appetite
  • Numbness or tingling in fingers and toes in just over 3 out of 10 people (30%), which can cause difficulty with fiddly things such as doing up buttons – this starts within a few days or weeks of starting treatment. Your doctor may suggest you have a reduced dose of eribulin or stop treatment for a while
  • Feeling or being sick in about 3 out of every 10 people (30%), but this is usually well controlled with anti sickness medicines
  • Constipation in 1 out of 4 people (25%) – your doctor or nurse may give you laxatives to help prevent this but do tell them if you are constipated for more than 3 days
  • Aching muscles and joints
  • Diarrhoea in about 1 out of 5 people (20%) – drink plenty of fluid and tell your doctor or nurse if diarrhoea becomes severe, or continues for more than 3 days
  • Headaches
  • Temperature, chills and flu like symptoms
  • Women may stop having periods (amenorrhoea) but this may be temporary
 

Occasional side effects

Between 1 and 10 in every 100 people have one or more of these.

  • A sore or dry mouth
  • Some people develop soreness, redness and peeling of the palms of the hands and soles of the feet, (Palmar–Plantar syndrome) which may cause tingling, numbness, pain and dryness
  • Vertigo or dizziness – don't drive or operate machinery if you feel dizzy
  • Bruising more easily due to a drop in platelets – you may have nosebleeds, bleeding gums after brushing your teeth, or lots of tiny red spots or bruises on your arms or legs (known as petechia)
  • Indigestion or heart burn
  • Abdominal (tummy) pain
  • Weight loss
  • Eye problems including blurred vision, sore, itchy, dry eyes, or infection – eye drops can help
  • Low levels of potassium in your blood (hypokalaemia) – you will have blood tests to check the levels of potassium and other compounds, such as calcium, magnesium and phosphate
  • Changes in blood sugar levels – you will have regular blood tests to check this. If you are diabetic you may need to adjust your diabetic medicines 
  • Taste changes
  • Sleep problems
  • Fast heart rate and skin flushing
  • A skin rash, or dry red skin, or nail changes
  • Liver changes that are very mild and unlikely to cause symptoms – the liver will almost certainly go back to normal when treatment finishes, but you will have regular blood tests to check how well your liver is working
  • Shortness of breath and a cough
  • Sadness or depression
  • Sweating more than usual, including at night
 

Rare side effects

Fewer than 1 in 100 people have these effects.

  • Shingles or cold sores
  • Ringing in the ears (tinnitus) – tell your doctor or nurse if you have this
  • Blood clots in the leg or lung – tell your doctor or nurse straight away if you have a red, hot or swollen leg or if you have sudden chest pain and breathlessness
  • High levels of bilirubin in the blood
  • Kidney changes that are mild and unlikely to cause symptoms – they will usually go back to normal when treatment finishes, but you will have regular blood tests to check how well your kidneys are working
  • Pain when passing urine – drink plenty of fluids and let your doctor or nurse know if you have this
 

Important points to remember

You won’t get all these side effects. A side effect may get worse through your course of treatment. Or you may have more side effects as the course goes on. This depends on

  • How many times you've had a drug before
  • Your general health
  • How much of the drug you have (the dose)
  • Other drugs you are having

Coping with side effects

Talk to your doctor, pharmacist or nurse about all your side effects so they can help you manage them. They can give you advice or reassure you. Your nurse will give you a contact number to ring if you have any questions or problems. If in doubt, call them.

Other medicines and supplements

Tell your doctor about any other medicines you are taking, including vitamins, herbal supplements and over the counter remedies. Some drugs can react together.

Contraception

This drug may have a harmful effect on a developing baby. It is important not to become pregnant while having treatment with eribulin and for 3 months afterwards. Talk to your doctor or nurse about contraception before having treatment if there is any chance that you could become pregnant.

Breastfeeding

Breastfeeding is not advisable during this treatment because the drug may come through in the breast milk.

Alcohol

Eribulin contains small amounts of alcohol. This is not harmful to most people but may be a problem if you have alcoholism.

 

Immunisations and chemotherapy

You should not have immunisations with live vaccines while you are having chemotherapy or for at least 6 months afterwards. In the UK, these include rubella, mumps, measles (usually given together as MMR), BCG, yellow fever and Zostavax (shingles vaccine).

You can have other vaccines, but they may not give you as much protection as usual until your immune system has fully recovered from your chemotherapy. It is safe to have the flu vaccine.

It is safe for you to be in contact with other people who've had live vaccines as injections. There can be problems with vaccines you take by mouth (oral vaccines), but not many people in the UK have these now. So there is usually no problem in being with any baby or child who has recently had any vaccination in the UK. You might need to make sure that you aren't in contact with anyone who has had oral polio, cholera or typhoid vaccination recently, particularly if you live abroad.

 

More information on eribulin mesylate

This page does not list all the very rare side effects of this treatment that are very unlikely to affect you. For further information look at the Electronic Medicines Compendium website at www.medicines.org.uk.

If you have a side effect not mentioned here that you think may be due to this treatment you can report it to the Medicines Health and Regulatory Authority (MHRA) at www.mhra.gov.uk.

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Updated: 5 September 2013