From the Research
CDK4/6 inhibitors may potentially impair postoperative wound healing due to their mechanism of action, which involves blocking cell cycle progression, and it is generally recommended to temporarily discontinue them before and after surgery to minimize this risk. The medications, including palbociclib (Ibrance), ribociclib (Kisqali), and abemaciclib (Verzenio), work by inhibiting the cyclin-dependent kinases 4 and 6, which are crucial for the G1-S phase transition in the cell cycle 1. This inhibition could theoretically interfere with the proliferative phase of wound healing, where cell division is critical, particularly for fibroblasts and epithelial cells.
Some key factors to consider when evaluating the risk of impaired wound healing in patients taking CDK4/6 inhibitors include:
- The patient's overall health status and presence of comorbidities that may affect wound healing, such as diabetes, obesity, or malnutrition 2
- The type and dose of CDK4/6 inhibitor being used, as well as the duration of treatment
- The timing and type of surgery, with more complex or invasive procedures potentially carrying a higher risk of wound healing complications
- The presence of other medications or factors that may impair wound healing, such as steroids, non-steroidal anti-inflammatory drugs (NSAIDs), or radiation therapy 3
For patients undergoing planned surgery, it is generally recommended to temporarily discontinue CDK4/6 inhibitors before and after surgery, typically stopping 1 week before surgery and resuming 1-2 weeks after surgery when wound healing is well established. This recommendation is based on the medications' mechanism of action and their half-lives (approximately 24-36 hours) 1. The decision to hold therapy should be individualized based on the urgency of surgery, the patient's cancer status, and consultation between the oncologist and surgeon to balance cancer treatment needs with optimal surgical outcomes.
In terms of specific guidance, a recent review article published in 2023 provides recommendations for reducing risks for poor surgical wound healing, including screening patients for prior irradiation, cigarette or e-cigarette use, chronic steroid use, alcoholism, diabetes, malnutrition, and other chronic medical conditions and medications 3. Additionally, understanding the basic physiologic events in normal wound healing and potential impediments to its end can help plastic surgeons maximize postoperative outcomes and avoid unnecessary surgical interventions 4.