From the Research
Ribociclib is not contraindicated in patients with a left ventricular ejection fraction (LVEF) or KSIF less than 50%. However, caution is advised as ribociclib, a CDK4/6 inhibitor used in hormone receptor-positive, HER2-negative breast cancer, can potentially cause QT interval prolongation, which may be of concern in patients with pre-existing cardiac conditions 1. The main contraindications for ribociclib include hypersensitivity to the drug, congenital long QT syndrome, and concurrent use of medications known to prolong the QT interval. For patients with cardiac issues, including reduced ejection fraction, baseline ECG assessment and periodic monitoring during treatment are recommended. Dose adjustments may be necessary based on QT interval changes rather than LVEF or KSIF values specifically. If a patient develops significant QT prolongation during treatment, temporary discontinuation, dose reduction, or permanent discontinuation may be required depending on the severity. Patients should also be monitored for other potential side effects such as neutropenia, hepatotoxicity, and infections while on ribociclib therapy.
Key Considerations
- The risk of cardiovascular events with ribociclib should be considered, particularly in patients with pre-existing cardiac conditions 1.
- Baseline ECG assessment and periodic monitoring during treatment are crucial for patients with cardiac issues, including reduced ejection fraction.
- Dose adjustments may be necessary based on QT interval changes, and patients should be monitored for other potential side effects.
- The most recent study on the topic, published in 2023, suggests that abemaciclib may have a lower risk of major adverse cardiovascular events (MACE) compared to ribociclib 1.
- However, the decision to use ribociclib should be based on individual patient factors and the potential benefits and risks of treatment, as ribociclib has been shown to be effective in hormone receptor-positive, HER2-negative breast cancer.
Monitoring and Management
- Patients on ribociclib should be monitored regularly for QT interval prolongation and other potential side effects.
- Dose adjustments or discontinuation may be necessary if significant QT prolongation or other adverse events occur.
- The use of ribociclib in patients with severe renal impairment may require dose reduction, as suggested by a 2023 study 2.
- Patients should be educated on the potential risks and benefits of ribociclib and the importance of regular monitoring and follow-up.