Optimization of Adjuvant CDK46 Therapy : Pre-test

1.

K.H. is a 33-year-old premenopausal woman diagnosed with stage IIIB HR-positive/HER2-negative invasive ductal carcinoma with a 7-cm tumor and 2 positive lymph nodes. She has been presented with options to initiate ribociclib or abemaciclib in addition to endocrine therapy. As the pharmacist in the clinic, you have been asked to discuss the differences between the 2 to assist with the patient’s decision-making.

In discussions with patients considering adjuvant CDK4/6inhibitors, which of the following would be accurate to tell them regarding the efficacy endpoints for their respective trials?

A. Both medications have demonstrated an OS benefit
B. Both medications reduce distant recurrence but not local recurrence
C. Both medications reduce recurrence risk; abemaciclib demonstrated an OS benefit
D. Both medications reduced recurrence risk only during the active treatment period

2.

A.F. is a 42-year-old premenopausal woman diagnosed with stage IIIA HR-positive/HER2-negative invasive ductal carcinoma. Initial imaging revealed a 5.2-cm tumor and 1 positive axillary lymph node with micrometastatic involvement (N1mi).

She received neoadjuvant ddAC/T, which was well tolerated.

She presents to the clinic after pathology from her bilateral mastectomy revealed treatment response with a decrease in tumor size to 3 cm and no remaining lymph node disease, corresponding to a pathologic stage IIA disease

At today’s office visit, an ECG is obtained, revealing a QTcF of 460 ms.

Which of the following adjuvant CDK4/6 inhibitors is the most appropriate choice for this patient?

A. Palbociclib + tamoxifen
B. Ribociclib + tamoxifen
C. Abemaciclib + letrozole + ovarian suppression
D. Ribociclib + anastrozole + ovarian suppression

3.

J.C. is a 56-year-old postmenopausal woman with pT2N1 HR-positive/HER2-negative early breast cancer. She completed AC-T and started on letrozole + adjuvant abemaciclib therapy 10 days ago.

Her baseline labs are normal.

Today she reports loose stools (3-4/day above baseline) since Day 3; she is taking fluids but no added antidiarrheal yet.

CBC today shows ANC 0.95 x 10⁹/L, although she is afebrile and well-appearing.

J.C. is expressing concern about “being on this medication for 2 years if this diarrhea keeps happening.” Beyond antidiarrheal therapy, what pharmacist-led strategy is most likely to prevent treatment interruption?

A. Reassure that diarrhea improves and encourage PRN antidiarrheal use
B. Counsel patient and plan follow-up within 72 hours with diet guidance and escalation criteria
C. Recommend daily prophylactic antidiarrheals for the rest of therapy
D. Preemptively hold abemaciclib at the next visit to prevent worsening symptoms

4.

A.C. is a 58-year-old woman receiving adjuvant ribociclib + ET who presents at Month 4 with grade 3 neutropenia (ANC 800/µL) but is otherwise asymptomatic. She is highly motivated to continue therapy but is concerned about the dose changes affecting efficacy.

What is the most appropriate pharmacist-led intervention?

A. Continue current dose and repeat labs in 4 weeks
B. Hold ribociclib until recovery to grade <2, then resume at the same dose
C. Hold ribociclib until recovery to grade <2, then resume at a reduced dose
D. Switch to abemaciclib to avoid further neutropenia

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Translating Evidence Into Practice: Pharmacist-Led Optimization of Adjuvant CDK4/6 Therapy in High-Risk HR+/HER2- Early Breast Cancer

Rodney Hunter, PharmD, BCOP

Julia L. Ziegengeist, PharmD, BCOP

Pretest

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