Eribulin (Halaven)

Eribulin is a chemotherapy drug. It's also known as Halaven. It's a treatment for breast cancer and liposarcoma that has:

• spread to surrounding tissue (locally advanced cancer)
• spread to other areas of the body (metastatic or advanced cancer)
• come back after having chemotherapy (relapsed or recurrent cancer)

How eribulin works

Eribulin is a type of chemotherapy. It destroys quickly dividing cells, such as cancer cells.

It works by stopping the cancer cells from separating into two new cells. So, it blocks the growth of the cancer.

How do you have eribulin?

You have eribulin as a drip into your bloodstream (intravenous).

You might have treatment through a long plastic tube that goes into a large vein in your chest. The tube stays in place throughout the course of treatment. This can be a:

• central line
• PICC line
• portacath

If you don't have a central line

You might have treatment through a thin short tube (a cannula) that goes into a vein in your arm. You have a new cannula each time you have treatment.

How often do you have eribulin?

You usually have eribulin in cycles of treatment. Each cycle of treatment lasts 21 days (3 weeks). You have each cycle in the following way:

You then start a new cycle of treatment. 

You have eribulin for as long as it’s working, and the side effects aren’t too bad.

Tests

You have blood tests before and during your treatment. They check your levels of blood cells and other substances in the blood. They also check how well your liver and kidneys are working.

What are the side effects of eribulin?

Side effects can vary from person to person. They also depend on what other treatments you're having. 

When to contact your team

Your doctor, nurse or pharmacist will go through the possible side effects. They will monitor you during treatment and check how you are at your appointments. Contact your advice line as soon as possible if:

• you have severe side effects 

• your side effects aren’t getting any better

• your side effects are getting worse

Early treatment can help manage side effects better. 

We haven't listed all the side effects here. Remember it is very unlikely that you will have all of these side effects. But you might have some of them at the same time.

Common side effects

These side effects happen in more than 10 in 100 people (more than 10%). You might have one or more of them. They include:

Increased risk of getting an infection

Increased risk of getting an infection is due to a drop in white blood cells. Symptoms include a change in temperature, aching muscles, headaches, feeling cold and shivery and generally unwell. You might have other symptoms depending on where the infection is.

Infections can sometimes be life threatening. You should contact your advice line urgently if you think you have an infection. 

Breathlessness and cough 

You might be breathless and look pale due to a drop in red blood cells. This is called anaemia.

You might also feel breathless due to an infection in your lung, such as pneumonia. Or it could be caused by changes in the lung tissue making it less flexible. Symptoms include coughing up green or yellow mucous, shallow breaths, and a fast heartbeat. You might have a high temperature or feel generally unwell.

Rarely, you may have scarring of the lung which can also cause problems with breathing.

Contact your advice line if you have any of these symptoms.

Loss of appetite and weight loss

You might lose your appetite for various reasons while having cancer treatment. Sickness, taste changes or tiredness can put you off food and drinks.

You might also lose weight while having this treatment. Let your doctor or nurse know, they can give you advice on diet. Or they can refer you to a dietitian.

Numbness or tingling in fingers and toes

Numbness or tingling in fingers or toes is often temporary and can improve after you finish treatment. Tell your healthcare team if you're finding it difficult to walk or complete fiddly tasks such as doing up buttons. 

Headaches 

Tell your healthcare team if you keep getting headaches. They can give you painkillers to help.

Feeling or being sick 

Feeling or being sick is usually well controlled with anti sickness medicines. It might help to avoid fatty or fried foods, eat small meals and snacks and take regular sips of water. Relaxation techniques might also help.

It is important to take anti sickness medicines as prescribed even if you don’t feel sick. It is easier to prevent sickness rather than treat it once it has started.

Constipation or diarrhoea 

Tell your healthcare team if you have diarrhoea or constipation. They can give you medicine to help. 

Hair loss

You could lose all your hair. This includes your eyelashes, eyebrows, underarms, legs and sometimes pubic hair. Your hair will usually grow back once treatment has finished but it is likely to be softer. It may grow back a different colour or be curlier than before. 

Pain in different parts of your body 

You might get aching or painful joints or muscles. You may also get pain in your back, arms, and legs. Less commonly you may have pain in your tummy (abdomen), bones, or chest.

Tell your doctor or nurse if you have any pain. They can give painkillers to help.

Tiredness and feeling weak 

You might feel very tired and as though you lack energy.

You might also be less able to concentrate, but this is not as common. Various things can help you to reduce tiredness and cope with it, for example, exercise. Some research has shown that taking gentle exercise can give you more energy. It is important to balance exercise with resting.

Occasional side effects

These side effects happen in between 1 and 10 out of every 100 people (between 1 and 10%). You might have one or more of them. They include:

• low levels of potassium, magnesium, phosphate, and calcium in your body. You have regular tests to check this
• loss of fluids in your body (dehydration)
• high blood sugar levels
• difficulty sleeping
• very low mood (depression)
• taste changes
• dizziness and vertigo
• nerve problems that can cause loss of sensation. This means you may not feel temperature or pain in different parts of your body
• problems with your eyes such as watery eyes and inflammation (conjunctivitis)
• ringing or buzzing in the ears
• hot flushes
• blood clots that can be life threatening; symptoms include pain, redness, and swelling where the clot is. Feeling breathless can be a sign of a blood clot in the lung. Contact your advice line or doctor straight away if you have any of these symptoms
• a drop in the levels of platelets which can cause bruising and bleeding- including nose bleeds
• a sore inflamed or dry mouth, rarely you may also develop mouth ulcers
• heartburn or acid reflux - symptoms might include a burning sensation in the middle of your chest, bloating, burping, feeling sick, and bad breath
• changes to the way your liver works which are usually mild, it can cause liver damage, but this is rare. You have blood tests to check this
• skin problems such as rash, itching and dry skin
• changes in your nails, for example they might break easily
• soreness, redness, and peeling on palms or soles of the feet
• pain when you wee or rarely you might have blood or protein in your wee
• swelling (oedema) in your hands and feet
• inflammation in your nose - you may have a runny nose or notice you are sneezing more
• changes with your nervous system, symptoms include weakness or difficulty controlling movement of your arms and legs, lack of concentration, forgetfulness, and changes in your eyesight
• fast heartbeat (tachycardia)
• swollen tummy
• heavy sweating
• inflammation of the lining of the digestive tract
• flu-like symptoms, such as fever, a sore throat, and cough
• weak muscles, you may also have painful muscle spasms- this is caused by uncontrolled movement in the muscles

Rare side effects

These side effects happen in fewer than 1 in 100 people (less than 1%). You might have one or more of them. They include:

• inflammation of the pancreas - symptoms include severe tummy pain, feeling or being sick, a high temperature or you may have loose poo
• swelling under the skin (skin angioedema)
• your kidneys stop working properly, symptoms might include passing small amounts of wee, or not being able to pass wee, darker looking wee, bloating around the tummy, swollen ankles, feet, or hands

Other side effects

There isn't enough information to work out how often these side effects might happen. They include:

• a severe skin reaction that may start as tender red patches which leads to peeling or blistering of the skin. You might also have a fever and your eyes may be more sensitive to light. This is serious and could be life threatening
• a serious condition causing blood clots to develop throughout the body and internal bleeding

Coping with side effects

We have more information about side effects and tips on how to cope with them.

What else do I need to know?

Other medicines, foods, and drink

Cancer drugs can interact with medicines, herbal products, and some food and drinks. We are unable to list all the possible interactions that may happen. An example is grapefruit or grapefruit juice which can increase the side effects of certain drugs.

Tell your healthcare team about any medicines you are taking. This includes vitamins, herbal supplements and over the counter remedies. Also let them know about any other medical conditions or allergies you may have.

Loss of fertility 

It is not known whether this treatment affects fertility in people. Talk to your doctor before starting treatment if you think you may want to have a baby in the future.

Pregnancy and contraception 

This drug may harm a baby developing in the womb. It is important not to become pregnant or get someone pregnant while you are having treatment with this drug and for at least 3 months afterwards.

Talk to your doctor or nurse about effective contraception before starting treatment. Let them know straight away if you or your partner become pregnant while having treatment.

Breastfeeding 

It is not known whether this drug comes through into the breast milk. Doctors usually advise that you don’t breastfeed during this treatment.

Treatment for other conditions 

If you are having tests or treatment for anything else, always mention your cancer treatment. For example, if you are visiting your dentist.

Immunisations 

Don’t have immunisations with live vaccines while you’re having treatment and for up to 12 months afterwards. The length of time depends on the treatment you are having. Ask your doctor or pharmacist how long you should avoid live vaccinations.

In the UK, live vaccines include rubella, mumps, measles, BCG, yellow fever and one of the shingles vaccines called Zostavax.

You can have:

• other vaccines, but they might not give you as much protection as usual
• the flu vaccine (as an injection)
• the coronavirus (COVID-19) vaccine - talk to your doctor or pharmacist about the best time to have it in relation to your cancer treatment

Members of your household who are aged 5 years or over are also able to have the COVID-19 vaccine. This is to help lower your risk of getting COVID-19 while having cancer treatment and until your immune system recovers from treatment.

Contact with others who have had immunisations - You can be in contact with other people who have had live vaccines as injections. Avoid close contact with people who have recently had live vaccines taken by mouth (oral vaccines) such as the oral typhoid vaccine. Sometimes people who have had the live shingles vaccine can get a shingles type rash. If this happens they should keep the area covered.

If your immune system is severely weakened, you should avoid contact with children who have had the flu vaccine as a nasal spray as this is a live vaccine. This is for 2 weeks following their vaccination.

Babies have the live rotavirus vaccine. The virus is in the baby’s poo for about 2 weeks and could make you ill if your immunity is low. Get someone else to change their nappies during this time if you can. If this isn't possible, wash your hands well after changing their nappy.

More information about this treatment

For further information about this treatment and possible side effects go to the electronic Medicines Compendium (eMC) website. You can find the patient information leaflet on this website.

You can report any side effect you have to the Medicines Health and Regulatory Authority (MHRA) as part of their Yellow Card Scheme.