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Ribociclib-Induced hepatotoxicity exacerbated by fenugreek supplement use: A case report.

Yousra Al Harrak1, Sihame Lkhoyaali1, Oumaima Lamsyah1

  • 1Department of Medical Oncology, National Institute of Oncology, CHU Ibn Sina, Rabat, Morocco.

Journal of Oncology Pharmacy Practice : Official Publication of the International Society of Oncology Pharmacy Practitioners
|May 19, 2025
PubMed
Summary

Fenugreek supplements may interact with ribociclib, a common breast cancer drug, potentially causing liver damage. Discontinuing fenugreek helped resolve drug-induced liver injury in a patient undergoing cancer treatment.

Keywords:
Ribociclibfenugreekhepatotoxicityherb-drug interactionmetastatic breast cancer

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Area of Science:

  • Oncology
  • Pharmacology
  • Hepatology

Background:

  • Cyclin-dependent kinase 4 and 6 (CDK4/6) inhibitors like ribociclib are standard treatments for ER+, HER2- metastatic breast cancer.
  • Ribociclib can cause hepatotoxicity, and the influence of concurrent dietary supplements on this side effect is not fully understood.
  • Herb-drug interactions are an underrecognized factor in cancer treatment management.

Purpose of the Study:

  • To report a case of probable herb-drug interaction between fenugreek and ribociclib leading to severe hepatotoxicity.
  • To highlight the potential for fenugreek supplements to exacerbate ribociclib-induced liver injury.
  • To emphasize the importance of screening for herbal supplement use in patients receiving CDK4/6 inhibitors.

Main Methods:

  • A case presentation of a 47-year-old woman with metastatic breast cancer who developed grade III hepatotoxicity after starting ribociclib.
  • Utilized the Roussel Uclaf Causality Assessment Method (RUCAM) and Naranjo Adverse Drug Reaction Probability Scale to assess causality.
  • Employed the Drug Interaction Probability Scale (DIPS) to evaluate the likelihood of an herb-drug interaction.

Main Results:

  • The patient experienced grade III hepatotoxicity attributed to ribociclib, with elevated transaminase levels persisting after drug discontinuation.
  • A probable drug-induced liver injury was initially identified (RUCAM score: 6), which decreased upon identifying concurrent fenugreek use (RUCAM score: 4).
  • A probable herb-drug interaction between ribociclib and fenugreek was suggested by the DIPS score (5), indicating fenugreek's role in modulating CYP3A4, which metabolizes ribociclib.

Conclusions:

  • Concurrent use of fenugreek supplements may contribute to or cause hepatotoxicity in patients treated with ribociclib.
  • This case underscores the critical need for oncologists to inquire about and manage potential herb-drug interactions.
  • Patients should be counseled regarding the risks associated with herbal supplements during cancer therapy.