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Ribociclib-induced liver injury: a case report
Sofia Schaeffer1, Christian Lutz1, Michael Dobbie2
1University Centre for Gastrointestinal and Liver Diseases, Basel, Switzerland.
Frontiers in Oncology
|December 18, 2023
Summary
Ribociclib, a CDK4/6 inhibitor for breast cancer, can cause severe drug-induced liver injury (DILI). Prompt monitoring and intervention, including corticosteroids, are crucial for managing this rare but serious adverse event.
Area of Science:
- Oncology
- Hepatology
- Pharmacology
Background:
- Idiosyncratic drug-induced liver injury (DILI) is a rare cause of acute liver failure.
- Ribociclib is a CDK4/6 inhibitor used for advanced hormone-receptor-positive, HER2-negative breast cancer.
- Previous reports indicate ribociclib-associated hepatotoxicity without liver necrosis.
Observation:
- A 41-year-old female patient developed elevated liver enzymes during ribociclib treatment.
- The patient presented with jaundice and coagulopathy, leading to a liver biopsy.
- Biopsy revealed acute hepatitis with 30% parenchymal necrosis, and RUCAM score was 7 (probable).
Findings:
- This case highlights a severe idiosyncratic hepatocellular DILI (grade 3) induced by ribociclib.
- Treatment involved ribociclib withdrawal, prednisone, and N-acetylcysteine.
- Liver enzymes normalized within 8 weeks with prednisone tapering.
Implications:
- Routine liver enzyme monitoring during ribociclib therapy is essential.
- Prompt hepatologic work-up and treatment interruption are recommended for liver enzyme elevation.
- Corticosteroid treatment should be considered for severe necroinflammation in ribociclib-induced DILI.
