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Ribociclib offers survival benefits for advanced HR+ HER2- breast cancer but risks liver injury. Corticosteroids may effectively manage severe drug-induced liver injury when drug cessation is insufficient.

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Area of Science:

  • Oncology
  • Hepatology
  • Pharmacology

Background:

  • Ribociclib combined with endocrine therapy improves survival in advanced HR+ HER2- breast cancer.
  • Hepatotoxicity is a known risk associated with ribociclib treatment.
  • Current guidelines offer limited management strategies for severe hepatotoxicity unresponsive to drug withdrawal.

Purpose of the Study:

  • To present a case of severe ribociclib-induced liver injury (DILI).
  • To highlight the potential benefit of corticosteroids in managing severe DILI from CDK4/6 inhibitors.
  • To suggest a management approach for refractory hepatotoxicity in patients receiving ribociclib.

Main Methods:

  • A case report of a patient with de novo metastatic HR+ HER2- breast cancer.
  • Monitoring of liver function tests (AST and ALT) during ribociclib and anastrozole treatment.
  • Evaluation for drug-induced liver injury and subsequent management with medication cessation and corticosteroid therapy.

Main Results:

  • The patient developed Grade 4 hepatotoxicity despite holding ribociclib.
  • Drug-induced liver injury from ribociclib was confirmed as the cause.
  • Initiation of a prolonged course of corticosteroids led to remarkable resolution of transaminitis.

Conclusions:

  • Severe hepatotoxicity from ribociclib can occur despite drug cessation.
  • Empiric corticosteroid therapy should be considered for patients experiencing severe, persistent hepatotoxicity from CDK4/6 inhibitors.
  • This approach may offer a viable management strategy for refractory DILI in this patient population.