Initial dosing | ||
Clinical definition | Dosing recommendations | |
Group 1 | Adequate liver functiona | 1.4 mg/m2 (equivalent to 1.23 mg/m2 eribulin [expressed as free base]) |
Group 2 | Bilirubin level: > ULN ≤ 1.5 × ULN | 1.1 mg/m2 |
Group 3 | Bilirubin level: > 1.5 × ULN or ALT/AST: ≥ 3 × ULN (for liver metastases, ALT/AST: ≥ 5 × ULN) | 0.7 mg/m2 b |
Subsequent dosing: day 8 | ||
Clinical finding | Dosing modification | |
Group 1 | ANC < 1.0 × 109/L and/or platelet count < 75 × 109/L; or nonhematological AE > grade 2c | Postpone treatment until recovery |
Group 2 | ANC < 1.0 × 109/L and/or platelet count < 75 × 109/L; or nonhematological AE > grade 2c | Postpone treatment until recovery |
Group 3 | ANC < 1.0 × 109/L and/or platelet count < 75 × 109/L; or nonhematological AE > grade 2c | Postpone treatment; omit day 8 |
Recovery on day 15 or earlier | ||
Clinical action | Dosing modification | |
Group 1 | Resume treatment on the day that recovery is observed (considered new day 8 of cycle) | 1.1 mg/m2 |
Group 2 | Resume treatment on the day that recovery is observed (considered new day 8 of cycle) | 0.7 mg/m2 |
Recovery after day 15 | ||
Clinical action | Dosing modification | |
Group 1 | Omit day 8 and resume scheduled treatment on day 1 of next cycle | 1.1 mg/m2 |
Group 2 | Omit day 8 and resume scheduled treatment on day 1 of next cycle | 0.7 mg/m2 |
Special considerations: | ||
• Grade 4 neutropenia > 7 days | ||
• Grade 3/4 neutropenia with fever or infection requiring treatment with growth factors and/or antibiotics | ||
• Grade 4 thrombocytopenia | ||
• Grade 3 thrombocytopenia requiring platelet and/or blood transfusion | ||
• Nonhematologic grade 3–4 toxicities | ||
Clinical action | Dosing modification | |
Group 1 | Resume treatment on day 1 of next cycle | 1.1 mg/m2 |
Group 2 | Resume treatment on day 1 of next cycle | 0.7 mg/m2 |
Group 3 | Consider stopping treatment with eribulin mesylate | |
Dose escalationd | ||
Clinical action | Dose modification | |
Group 2 and 3 | If, following cycle 1 day 1 and cycle 1 day 8, there are no toxicity issues (especially hematological toxicities determined by ANC and platelets), consider increasing dose at the start of the next cycle Refer to day 8 of this table to assess hematological and nonhematological toxicities at the next dose level; reduce dose if necessary | Next dose level |