CONCLUSION
Approaches for mBC management have evolved in recent years; however, chemotherapy remains the mainstay of treatment for patients with advanced disease. Eribulin is a microtubule dynamics inhibitor indicated in several Asian countries as second- and later-line chemotherapy for mBC patients pretreated with an anthracycline and a taxane. While there is limited clinical trial data for the use of eribulin in the Asian patient population, the drug has been evaluated in two global, randomized phase III studies. In the EMBRACE study, eribulin showed a significant and clinically meaningful improvement in the OS compared with TPC in heavily pretreated mBC patients. Study 301 evaluated eribulin versus capecitabine in patients who had received prior anthracycline and taxane treatment. Although the co-primary endpoints of OS and PFS for eribulin superiority over capecitabine in this study were not met, there was a numerical difference in the median OS in favor of eribulin. Furthermore, a pooled analysis of these two studies suggests that eribulin may specifically confer OS benefits to patients with HER2-negative and TN disease when compared with the control treatment. The benefit of eribulin as a single agent in this setting suggests that this drug could become a new standard of care [21]. Eribulin is generally well tolerated although neutropenia may occur at a higher frequency among Asian patients receiving eribulin after several lines of systemic therapy. The most common AEs are manageable with the supportive measures highlighted in this paper. Collectively, the phase III trials' data and our clinical experience support the use of eribulin as a potential treatment option for mBC in Asian patients. The efficacy and safety of eribulin in combination with other agents for advanced breast cancer, including capecitabine [34]; carboplatin (NCT 01372579); poly (ADP-ribose) polymerase inhibitors such as olaparib (NCT02000622) and talazoparib (NCT01945775); the programmed death 1 immune checkpoint inhibitor, pembrolizumab (NCT02513472); and the mammalian target of rapamycin inhibitor, everolimus (NCT02120469, NCT 02616848), are currently being explored in the setting of HER2-negative, TN, and BRCA-mutated breast cancer. Results from ongoing clinical trials in the adjuvant setting after doxorubicin and cyclophosphamide for HER2-negative disease (NCT01328249), capecitabine for estrogen receptor-positive disease (NCT01439282), and in the neoadjuvant setting with carboplatin (NCT01372579) for TN breast cancer are also awaited.