Common Adverse Events Associated With CDK4/6 Inhibitors

EP: 1.How CDK4/6 Inhibitors Enable More Personalized Treatment in HR+ mBC

EP: 2.CDK4/6 Inhibition Customizes Frontline HR+, HER2- mBC Treatment

EP: 3.Routine Helps Patients With Breast Cancer on CDK4/6 Inhibitors Gain Independence

EP: 4.Encouraging CDK4/6 Adherence Through Emotional Awareness

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EP: 5.Common Adverse Events Associated With CDK4/6 Inhibitors

For patients with hormone receptor (HR)–positive breast cancer, CDK4/6 inhibitors are the frontline option, but choosing which inhibitor is right for a patient requires consideration of the adverse effects (AEs) most associated with each medication.

In an interview with Oncology Nursing News following a Case-Based Roundtable discussion, Courtney Moore, APRN, FNP-C, OCN, explained considerations advanced practice providers (APPs) and nurses should take when a patient is starting treatment.

Moore, a nurse practitioner at Norton Cancer Institute Medical Oncology and Hematology, said that because neutropenia is associated with treatment with palbociclib (Ibrance) and ribociclib (Kisqali), patients’ complete blood counts (CBCs) should be monitored to keep track of neutrophil count and watch out for other cytopenias. For patients taking either medication, patients should be monitored every 2 weeks for the “first couple of cycles,” and for patients taking ribociclib, CBCs should be monitored monthly afterward.

Patients’ QTc should also be monitored with EKG, and hepatic function should be observed with comprehensive metabolic panel (CMP) labs.

Additionally, diarrhea is associated with abemaciclib (Verzenio), and Moore mentioned that patients can be prescribed a medication like loperamide (Imodium) or diphenoxylate and atropine (Lomotil).

Transcript

With palbociclib and ribociclib, one of the biggest AEs is neutropenia. We really monitor our patients’ CBCs. They need to come in every 2 weeks for the first couple of cycles, and then we’ll watch it monthly after that for ribociclib.

But another thing is the QTc. We’re going to be doing EKGs at baseline, and then 2 weeks after they start the medication, and as needed from there, there is also concern for hepatic toxicities, especially with the ribociclib, so we will be checking their CMP throughout the process as well, to make sure we’re not seeing an uptick in any of the liver enzymes.

Then, generally, these medications can cause some fatigue. Abemaciclib can cause diarrhea. We need to hone in with the patient on these follow ups. When we’re checking for labs or doing EKGs, we can talk to them about any of these other AEs and how we can manage those. If they’re having a lot of diarrhea, prescribe Imodium or Lomotil, or something like those medications, to help bring those AEs down as much as possible.

This transcript has been edited for clarity and conciseness.