Abstract
A 59-year-old woman presented with a bone-only metastatic luminal breast cancer. She received first-line treatment with aromatase inhibitors associated with a cyclin-dependent kinase (CDK) 4/6 inhibitor, ribociclib. She developed Grade 3 elevated transaminases leading us to interrupt ribociclib permanently. Specific toxicity of the CDK 4/6 inhibitor ribociclib was retained. Once transaminase levels normalized, the patient initiated another CDK4/6 inhibitor, palbociclib, using an escalating dose without reappearance of hepatic injury. This case suggests the possibility of rechallenge after hepatic toxicity with a different CDK 4/6 inhibitor using dose escalation and careful monitoring.
Keywords:
CDK 4/6 inhibitor; elevated transaminase; hepatic toxicity; luminal breast cancer; rechallenge.
© 2019 Wiley Periodicals, Inc.
MeSH terms
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Alanine Transaminase / blood
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Aminopyridines / adverse effects*
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Aromatase Inhibitors / therapeutic use
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Aspartate Aminotransferases / blood
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Bone Neoplasms / drug therapy*
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Bone Neoplasms / secondary
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Breast Neoplasms / pathology*
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Carcinoma, Lobular / drug therapy*
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Carcinoma, Lobular / secondary
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Chemical and Drug Induced Liver Injury / blood
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Chemical and Drug Induced Liver Injury / etiology*
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Cyclin-Dependent Kinase 4 / antagonists & inhibitors
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Cyclin-Dependent Kinase 6 / antagonists & inhibitors
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Drug Substitution
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Drug Therapy, Combination
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Female
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Humans
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Letrozole / therapeutic use
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Middle Aged
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Piperazines / therapeutic use*
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Protein Kinase Inhibitors / adverse effects*
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Protein Kinase Inhibitors / therapeutic use
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Purines / adverse effects*
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Pyridines / therapeutic use*
Substances
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Aminopyridines
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Aromatase Inhibitors
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Piperazines
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Protein Kinase Inhibitors
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Purines
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Pyridines
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Letrozole
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Aspartate Aminotransferases
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Alanine Transaminase
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Cyclin-Dependent Kinase 4
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Cyclin-Dependent Kinase 6
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palbociclib
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ribociclib