Ixempra (ixabepilone) for Breast Cancer

Ixempra (ixabepilone) is a chemotherapy drug approved by the U.S. Food and Drug Administration (FDA) in 2007 to treat advanced cases of breast cancer that have spread either locally or to distant parts of the body (metastasized). It is used after certain other drugs have been tried but have proven ineffective, either immediately or after a duration of use. Ixempra may be less likely than some other cancer drugs to become tumor-resistant or ineffective over time.

This drug is used to treat locally advanced breast cancer (in which a tumor has spread to nearby areas such as the skin or chest wall, or to lymph nodes in the armpit area) and metastatic breast cancer (that which has spread to another part of the body, like the lungs).

Ixempra is prescribed primarily for patients whose tumors are resistant to or no longer benefiting from anthracyclines such as Adriamycin (doxorubicin), taxanes such as Taxol (paclitaxel), and Xeloda (capecitabine).

Ixempra is in a class of chemotherapy drugs called epothilones. It works as an antimicrotubule agent. That is, the drug attaches to a section of the microtubule (a cell component), stabilizing it and interrupting cell division. This slows or prevents the growth of tumors.

Ixempra is administered as an intravenous infusion into a vein or chemotherapy port. It can be given alone or in conjunction with the oral drug Xeloda. A 2017 study found that Ixempra plus Xeloda was superior to Xeloda alone in improving survival in patients with metastatic breast cancer. 

Ixempra is usually given once every three weeks, and infusions take about three hours each. About an hour before your infusion, you will be given medications that reduce your chance of an allergic reaction.

Your precise dosage of Ixempra depends on many factors, including your height and weight, your general health/other health problems, and the type of cancer being treated. A doctor or nurse must administer Ixempra.

You will be monitored regularly while getting your infusion to assess your response to therapy. Periodic blood work to check your complete blood count (CBC) and the function of other organs (such as your kidneys and liver) will be ordered by your doctor.  

As with any drug, Ixempra carries the risk of potential side effects, not all of which will be experienced by everyone who takes it. Common side effects include:

• Nausea and vomiting
• Fatigue
• Appetite loss
• Hair loss
• Changes in fingernails and toenails
• Fever
• Anemia (low red blood cell count)
• Thrombocytopenia (low platelet count)
• Headache
• Joint and muscle pain
• Diarrhea or constipation
• Abdominal pain
• Sores on your lips, inside your mouth and esophagus
• Hand-foot syndrome (palmar-plantar erythrodysesthesia), characterized by tender, red, dry, and peeling skin
• Peripheral neuropathy: Neuropathy due to chemotherapy may cause numbness and pain in the hands and feet.

If Ixempra is used shortly after a patient receives radiation therapy, there is also a chance of developing an often overlooked complication known as radiation recall. This occurs due to inflammation in the region in which radiation is given and can result in skin redness, swelling, and blistering, among other symptoms.

Though steps are taken to mitigate the chance of allergic reactions, they are still possible. This could result in itching, hives, rash, and flushed face, but also heart palpitations, troubled breathing, and a swollen face, throat, or tongue.

Chemotherapy can also lead to neutropenia, low white blood cell count, which increases your susceptibility to infections that can become very serious—even life-threatening.

You should not take Ixempra under any of the following circumstances:

• You have poor liver function/liver problems
• Your white blood cell is lower than 1500 cells/mm3
• Your platelet counts are less than <100,000 cells/mm3
• You are pregnant: Ixempra is a pregnancy Category D drug, meaning it can harm a developing fetus.

Due to its mechanism of action, Ixempra may interact with several other medications, including, but not limited to:

• Antibiotics, such as clarithromycin, erythromycin, rifabutin, rifampin, rifapentine, or telithromycin
• Antifungal medications, such as itraconazole, ketoconazole, miconazole, posaconazole, or voriconazole
• Seizure medications, such as carbamazepine, felbamate, oxcarbazepine, phenytoin, or primidone

Talk to your oncologist before taking other medications or any nutritional supplements while using Ixempra.

Other considerations:

• Given the risks to a developing fetus, you'll have to use birth control if you're sexually active while taking Ixempra.
• The drug can be passed through breast milk, so you will not be able to breastfeed while taking it.
• Ixempra is also associated with future infertility; talk to your doctor before beginning this treatment if you plan to become pregnant.
• Since all chemotherapy drugs compromise the immune system, you may not be able to get vaccines during treatment.

As with any form of chemotherapy, Ixempra can take a toll on your energy. Try to eat healthily, exercise when you can, and get adequate rest during treatment.