Oncology Brothers: Practice-Changing Cancer Discussions Managing Toxicities of CDK4/6 Inhibitors in Hormone Positive Breast Cancer - Dr. Stephanie Graff
Oct 16, 2025
Dr. Stephanie Graff, a medical breast oncologist at Brown University Health, dives into the management of CDK4/6 inhibitor toxicities in hormone receptor-positive breast cancer. She discusses critical side effects of ribociclib, abemaciclib, and palbociclib, emphasizing the importance of shared decision-making with patients. Graff covers monitoring techniques, like EKGs for QT prolongation, and practical strategies for managing diarrhea and neutropenia. The insights shared make this a must-listen for anyone involved in cancer care.
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Prepare Patients Early For CDK4-6 Therapy
- Discuss likely need for a CDK4-6 inhibitor early, often before surgery, to prepare patients for adjuvant therapy.
- Use shared decision-making to match ribociclib vs abemaciclib to patient risk and side-effect preferences.
Trial Eligibility Shapes Drug Choice
- Ribociclib has broader trial eligibility than abemaciclib, influencing which patients receive it.
- Trial populations differ, so cross-trial comparisons of effect size can mislead treatment choice.
Monitor QT And Review Drug Interactions
- For ribociclib, obtain a baseline EKG and a follow-up EKG around one month, and review co-medications for QT risk.
- Warn patients about interacting agents (e.g., ondansetron, St. John's wort, grapefruit) and have them report new meds.