Nexerelin (Eribulin)

• Eribulin is used in oncology to target microtubule dynamics in solid tumours.
• Metastatic breast cancer: improves progression‑free survival in patients who have received prior chemotherapy.
• Advanced liposarcoma: provides disease control in patients with unresectable or metastatic disease.

• Eribulin binds to the plus ends of microtubules, preventing their elongation and promoting persistent microtubule shortening. This disruption of microtubule dynamics leads to G2‑M phase cell‑cycle arrest and triggers apoptosis in rapidly dividing cancer cells, thereby inhibiting tumor growth.

Adverse reactions may range from mild to severe and are monitored throughout therapy.

Common Side Effects

• Neutropenia: reduced white‑blood‑cell count increasing infection risk.
• Fatigue: persistent tiredness affecting daily activities.
• Nausea: upset stomach often managed with anti‑emetics.
• Alopecia: hair loss that may be temporary.
• Peripheral neuropathy: tingling or numbness in extremities.
• Constipation: difficulty passing stools.

Serious or Rare Side Effects

• Febrile neutropenia: fever with low neutrophil count requiring urgent care.
• Severe infections: bacterial or fungal infections due to immune suppression.
• Pulmonary toxicity: breathing difficulties or interstitial lung changes.
• Cardiac dysfunction: reduced heart function or arrhythmias.

Prior to initiating therapy, clinicians should assess baseline health and monitor patients regularly.

• Hematologic monitoring: perform complete blood counts before each dose to detect neutropenia.
• Hepatic function: evaluate liver enzymes as eribulin is metabolised hepatically.
• Renal function: adjust therapy if creatinine clearance is markedly reduced.
• Pregnancy and breastfeeding: avoid use; safety data are insufficient.
• Concomitant myelosuppressive agents: use with caution to prevent additive bone‑marrow toxicity.
• Store at ambient temperature: keep in original container, protect from light and moisture.

Eribulin may interact with other medicines that affect bone‑marrow function or drug metabolism.

Major Interactions (Avoid)

• Concurrent myelosuppressive chemotherapy: can cause profound neutropenia.
• Strong CYP3A4 inhibitors (e.g., ketoconazole): may increase eribulin exposure.
• Live vaccines: immunosuppression may reduce vaccine efficacy.

Moderate Interactions (Monitor Closely)

• CYP3A4 inducers (e.g., rifampicin): may lower eribulin levels.
• Anticoagulants (e.g., warfarin): monitor for altered bleeding risk.
• Neurotoxic agents (e.g., vincristine): increased risk of peripheral neuropathy.