Class of 2016 Abstract / Objectives: To determine the number of patients treated with eribulin who required an alternate dosing schedule other than “day 1/day 8” due to side effects. Methods: Chart reviews were conducted on all patients who met inclusion criteria. Data collected included patient demographics, history of surgery/radiation, number of past chemotherapy treatments, and lab values prior to each eribulin cycle. Results: A total of 37 patients met inclusion criteria for this study. Ten patients were initially started on the “day 1/day 8” schedule and 3 of those patients required a change to the extended “day 1/day 15” schedule. The remaining 27 patients were started on the extended schedule. Conclusions: The number of patients requiring a dosing schedule change due to side effects was not statistically significant. This finding was due to the fact that the majority of patients were started on an alternate dosing schedule in the beginning of treatment. More extensive studies would be required to determine if a majority of patients would require this alternate dosing schedule, and if this should be initiated in all patients starting on eribulin.

La migration et l'invasion tumorale sont des étapes clés de la cascade métastatique. Les microtubules (MT) contribuent à la division cellulaire et constitue la cible des agents de chimiothérapie anti-MT (ACM). Ce sont des structures dynamiques qui s'ancrent aux structures cellulaires périphériques. Durant ma thèse, j’ai étudié comment les protéines régulant le bout « + » des MT (+TIP) contribuent à la migration cellulaire et à la dégradation de la matrice extracellulaire. D’abord j’ai étudié l'impact de l'eribuline, un ACM dépolymérisant, sur la migration de cellules mammaires. L'éribuline s'est avérée empêcher l'ancrage des MT, modifier leur dynamique et inhiber la migration dirigée cellulaire, phénomène que nous avons expliqué par son action sur la +TIP EB1 mais surtout par la délocalisation de la tubuline polymérase ch-TOG de l'extrémité + des MT. Puis, nous avons examiné le rôle des +TIP dans la dégradation de la matrice, par les invadopodes, de petites protrusions riches en actine dégradant la matrice. La déplétion de EB1 et ses partenaires, APC et ACF7, régulaient négativement l’action des invadopodes, laissant supposer la présence d'un complexe fonctionnel : EB1, APC et ACF7 régulant négativement les invadopodes. En parallèle, par analyse protéomique systématique des composant des invadopodes, nous avons identifié de nouveaux proches voisins de TKS5, protéines indispensable à la formation des invadopodes, dont une protéine associée aux MT, MAP4. Au total, la régulation de la dynamique des +TIP est importante pour la migration et l'invasion et développer des stratégies ciblées contre ces acteurs pourrait améliorer la prise en charge du cancer du sein métastatique. / Migration and invasion are key steps in the metastatic cascade. Microtubules (MT) are involved in cell division and are dammaged by MT tagetting agents(MTA), a widely used chemotherapy drugs. MT are dynamic structures anchored to peripheral cell structures. During this work, I studied how proteins that regulates the "+" end of MT (+ TIP) cell migration and extracellular matrix degradation. First I adressed the impact of eribulin, a new depolymerizing MTA, on mammary cell migration. Eribulin was found to prevent the anchoring of MT to cell cortex, to modify their dynamics and to inhibit cell migration, a phenomenon that we explained by its action on +TIP EB1 but more precisely by the delocalization of tubulin polymerase ch-TOG. Next we investigated the role of TIPs in invadopodia matrix degradation , which are actin-rich protrusion specialized in matrix digestion. The depletion of EB1 and its partners, APC and ACF7, negatively regulated the action of invadopodia, assumed the presence of a complex complex: EB1, APC and ACF7 negatively regulating invadopodia activity. In parallel, by systematic proteomic analysis of the component of the invadopodia, we identified new close neighbors of TKS5, an essential proteins in invadopodia formation, including a MT associated protein MAP4. In conclusion, the regulation of + TIP dynamics is important for migration and invasion and developping targeted strategies against them could improve the management of metastatic breast cancer.

Eribulin is a non-taxane microtubule inhibitor approved for the treatment of metastatic breast carcinoma after two prior chemotherapeutic regimens. We report a patient with extended progression-free survival (PFS) of more than 57 months with metastatic breast carcinoma treated with eribulin in the third-line setting. A 48-year-old lady was diagnosed with stage IIA (pT2N0M0), high grade, triple-negative, invasive ductal carcinoma (IDC) of the left breast on core needle biopsy. She underwent neoadjuvant chemotherapy with adriamycin, and cyclophosphamide followed by a negative sentinel lymph node (SLN) biopsy. Subsequent mastectomy and axillary lymph node dissection revealed a 2.5 cm, high grade, triple-negative IDC with three additional lymph nodes negative for metastatic carcinoma, consistent with the initial diagnosis. Eight months into the surveillance program, the patient developed a 2.8 cm right lower lobe (RLL) lung mass with standard uptake value (SUV) of 27 on positron emission tomography-computed tomography (PET/CT). Core needle biopsy of the lung lesion revealed sheets of poorly differentiated carcinoma, immunophenotypically compatible with the initial diagnosis of breast pathology. She then commenced single-agent paclitaxel in the 1st line metastatic setting with a significant decrease in RLL lung mass to less than 1 cm with an SUV of 1.7 noted. The patient developed progression after seven months and started 2nd line gemcitabine noting initial improvement and subsequent stable disease for a period of 12 months. Eventual progression of RLL lung nodule measuring 2.1 cm with SUV of 10 noted. Initiated 3rd line eribulin with a notable response on imaging studies within three months and with no evidence of disease (NED) on scans over the subsequent 57 months. Eribulin related mild neuropathy superimposed on previous paclitaxel associated grade 2 neuropathy required a 20% eribulin dose reduction. The patient is currently clinically and radiographically stable with plateaued serum tumor markers. Our patient has shown excellent response and tolerance to eribulin with PFS of over 57 months (nineteen times the norm) which is rare.