What is the recommended anti-emetic regimen for patients taking Kisqali (ribociclib)?

From the Guidelines

The recommended anti-emetic regimen for patients taking Kisqali (ribociclib) should include a prophylactic regimen with a 5-HT3 receptor antagonist, dexamethasone, and a neurokinin-1 receptor antagonist, as this combination has been shown to be effective in preventing nausea and vomiting in patients with high emetogenic risk.

Key Considerations

• The use of a prophylactic antiemetic regimen is crucial in managing nausea and vomiting associated with Kisqali, as it can significantly impact the patient's quality of life 1.
• A 5-HT3 receptor antagonist, such as ondansetron or granisetron, should be administered before the start of treatment, along with dexamethasone and a neurokinin-1 receptor antagonist, such as aprepitant or fosaprepitant 1.
• Delayed nausea prophylaxis with dexamethasone on days 2-3 is also recommended, as it can help prevent delayed emesis 1.
• The use of olanzapine, according to local guidelines, can further help in the prevention of nausea and vomiting, especially in patients with a history of motion sickness or previous chemotherapy-induced nausea 1.

Patient Management

• Patients should be advised to take anti-emetics as prescribed, maintain adequate hydration, eat small frequent meals, and avoid spicy or greasy foods.
• If nausea becomes severe or persistent despite these measures, dose modification of Kisqali may be necessary, and patients should contact their healthcare provider.
• It is essential to monitor patients for signs of nausea and vomiting and adjust the antiemetic regimen as needed to ensure optimal management of symptoms and prevention of complications.

Additional Recommendations

• The choice of antiemetic regimen should be based on the individual patient's risk factors, medical history, and previous experiences with chemotherapy-induced nausea and vomiting 1.
• The use of a 5-HT3 receptor antagonist, such as palonosetron, may be preferred in some cases due to its longer half-life and efficacy in preventing delayed emesis 1.

From the Research

Anti-emetic Medication for Kisqali

The use of anti-emetic medication is crucial for patients taking Kisqali (ribociclib) to prevent chemotherapy-induced nausea and vomiting (CINV).

• According to the study 2, the most common adverse reactions observed in patients taking ribociclib were neutropenia, nausea, fatigue, diarrhea, leukopenia, alopecia, vomiting, constipation, headache, and back pain.
• A study 3 compared the efficacy and safety of two dexamethasone-sparing regimens with 3-day dexamethasone for the prevention of CINV during the delayed phase after moderately emetogenic chemotherapy.
• The study 3 found that dexamethasone-sparing regimens incorporating palonosetron or multiple-day metoclopramide are safe and at least as effective as standard treatment with a 3-day dexamethasone regimen with ondansetron in controlling delayed CINV and nausea.
• Another study 4 conditionally recommends using serotonin antagonists, such as ondansetron, and/or triptans, such as sumatriptan or aprepitant to abort symptoms of cyclic vomiting syndrome, which may be relevant for patients experiencing nausea and vomiting while taking Kisqali.
• However, it is essential to consider the potential drug-drug interactions between ribociclib and other medications, including anti-emetics, as reported in the study 5.
• The study 5 recommends avoiding concurrent use of strong CYP3A inhibitors/inducers and exercising caution when using CYP3A substrates with narrow therapeutic indices.
• A more recent study 6 reports the results of a prespecified interim analysis of invasive disease-free survival in patients with HR-positive, HER2-negative early breast cancer treated with ribociclib plus endocrine therapy, but does not provide specific guidance on anti-emetic medication.
• Based on the available evidence, the recommended anti-emetic regimen for patients taking Kisqali may include a combination of medications such as ondansetron, dexamethasone, and palonosetron, but the specific regimen should be determined by a healthcare professional considering the individual patient's needs and potential drug interactions 3, 2, 4, 5.