Myocardial dysfunction caused by abemaciclib: a case report

Profiling the Cardiovascular Toxicities of CDK4/6 Inhibitors: A Real-World Pharmacovigilance Study

Cyclin-dependent kinase 4 and 6 (CDK4/6) inhibitors are approved for the treatment of human epidermal growth factor receptor 2 (HER-2)-negative, hormone receptor-positive breast cancer. The cardiovascular toxicity of CDK4/6 inhibitors is not well understood. This study aims to profile the cardiac events associated with CDK4/6 inhibitors. Reports from 2015Q1 to 2024Q1 were obtained from the FDA Adverse Event Reporting System (FAERS). Reports identifying palbociclib, ribociclib, and abemaciclib as the primary suspect were examined for cardiovascular toxicity, including hypertension, cardiac failure, cardiomyopathy, arrhythmia, myocardial infarction, and myocarditis. Signal detection was performed using the proportional reporting ratio (PRR), reporting odds ratio (ROR), and information component (IC). A total of 69,139 reports were analyzed. The median time to adverse events was 69 days (interquartile range [IQR], 18-260 days). Of these, 2065 reports documented cardiac adverse events. Ribociclib and QT prolongation were re-confirmed as a signal (PRR 8.43, ROR 8.65, IC025 2.86). Hypertension and cardiac failure were the most frequently reported cardiovascular toxicities. This study demonstrates that the use of CDK4/6 inhibitors is associated with cardiovascular adverse events, such as heart failure and hypertension. Further research is needed to understand the mechanisms and risk factors contributing to the cardiovascular toxicity of CDK4/6 inhibitors.

The protective effect of curcumin on cardiac markers and fibrosis in abemaciclib-induced cardiac damage in rats

Abemaciclib (ABE) is a cyclin-dependent kinase inhibitor used in combination with an antiestrogen in the treatment of breast cancer. In addition to the important therapeutic properties of this drug, its side effects are not fully known. In this study, we aimed to investigate the protective effect of curcumin (CUR) on cardiac damage caused by ABE administration. Forty rats were equally divided into control, dimethyl sulfoxide (150 µL), CUR (30 mg/kg/day), ABE (26 mg/kg/day), and ABE + CUR (26 mg/kg/day ABE and 30mg/kg/day CUR) groups (n = 8). Injections were administered daily for 28 days. Troponin-I, total cholesterol, and creatine kinase myocardial band (CK-MB) levels and cardiac fibrosis were higher in the ABE group than in the control group (p < 0.05), and were lower in the ABE + CUR group than in the ABE group (p < 0.05). The results showed that ABE administration can cause cardiac damage and increase cardiac fibrosis. However, they showed that coadministration of CUR with ABE could suppress increases in CK-MB, troponin-I, and total cholesterol levels and also cardiac fibrosis associated with cardiac damage. Therefore, we can infer that the subsequent administration of CUR ABE treatment can be used as a therapeutic strategy for preventing cardiac damage.

Elevated transaminases and development of cardiomyopathy in a 32-year-old woman with metastatic breast cancer after treatment with ribociclib followed by palbociclib

INTRODUCTION

Cyclin-dependent kinase 4 and 6 inhibitors, ribociclib and palbociclib, are associated with reports of transaminitis and adverse cardiac events.

CASE REPORT

The patient is a previously healthy 32-year-old female diagnosed with estrogen receptor-positive, progesterone receptor-positive, and human epidermal growth factor 2 negative metastatic breast cancer. From July to September 2021, the patient was initiated on ribociclib followed by palbociclib for metastatic breast cancer. She subsequently experienced two episodes of transaminitis and was diagnosed with cardiomyopathy.

MANAGEMENT AND OUTCOME

The patient experienced transaminitis 2 weeks after the initiation of ribociclib resulting in discontinuation. When rechallenged with palbociclib, the patient experienced transaminitis within 1 week of initiation, which resulted in discontinuation. Approximately 1 month after palbociclib discontinuation, the patient was diagnosed with congestive heart failure with a left ventricular ejection fraction of 24%.

DISCUSSION

To our knowledge, there are few case studies investigating cyclin-dependent kinase 4 and 6 inhibitor rechallenge following transaminitis. Prior literature suggests that transaminitis with cyclin-dependent kinase 4 and 6 inhibitors is not a class effect, but this case report suggests otherwise. This report presents a rare case of cardiomyopathy and transaminitis following the administration of cyclin-dependent kinase 4 and 6 inhibitors, ribociclib and palbociclib.