Ribociclib induced acute kidney injury: A case report

J Oncol Pharm Pract. 2021 Dec;27(8):2023-2026. doi: 10.1177/10781552211007202. Epub 2021 Apr 13.

Abstract

Introduction: Among females, breast cancer is the most common type of cancer. Hormon receptor positive (HR+) subtype constitutes 75% of the diagnosed breast cancers. Combination of the cyclin D-cyclin-dependent kinase 4/6 (CDK4/6) inhibitor and endocrine therapy significantly improves overall survival and progression-free survival. Ribociclib is an oral CDK 4/6 inhibitor and some adverse effects are identified. According to MONALEESA 2-3-7 studies, no adverse effect (AE) were reported due to grade 3 or 4 acute kidney injury (AKI) that caused treatment discontinuation.

Case report: We report a ribociclib-induced grade 3 AKI in an elderly woman who was treated for metastatic breast cancer. During first cycle of therapy, she was admitted to the oncology clinic with diagnosis of AKI.Management and outcome: Ribociclib treatment was discontinued and secondary causes of AKI were excluded. During the follow-up, kidney function values returned to the normal range spontaneously. Ribociclib treatment was re-initiated by reducing the dose (400 mg daily). Despite dose reduction; grade 3 AKI recurred when ribociclib was re-initiated and the drug was permanently discontinued.

Discussion: According to MONALEESA 2-3-7 studies; no AE were reported due to grade 3 or 4 AKI. Despite these studies, the FDA reported that 20% of patients with ribociclib + letrozole combination therapy may have any stage elevation of creatinine. Ribociclib induced creatinine elevations are generally mild (grade 1-2) and can be managed by dose reduction or close monitoring of creatinine levels. We report the first case of grade 3 AKI that caused treatment discontinuation following administration of ribociclib.

Keywords: Ribociclib; acute renal injury; creatinine; cyclin dependent kinase 4/6 inhibitor; metastatic breast cancer treatment.

Publication types

  • Case Reports

MeSH terms

  • Acute Kidney Injury* / chemically induced
  • Aged
  • Aminopyridines / adverse effects*
  • Antineoplastic Combined Chemotherapy Protocols
  • Breast Neoplasms* / drug therapy
  • Female
  • Humans
  • Letrozole / therapeutic use
  • Neoplasm Recurrence, Local
  • Purines / adverse effects*
  • Receptors, Estrogen

Substances

  • Aminopyridines
  • Purines
  • Receptors, Estrogen
  • Letrozole
  • ribociclib