Managing CDKi Therapy in HR Positive HER2 Negative BC : Pre-test

1.

Patient Case 1 (cont’d)

Sally started adjuvant abemaciclib 2 mo ago

She calls to report 7-8 episodes a day of diarrhea despite taking as-needed antidiarrheal medication that is difficult to predict

She says her weight is stable and that she is eating and drinking without problems

She also noted fatigue despite adequate sleep and is having trouble returning to work as a result

You ask her to stop taking abemaciclib until her symptoms are resolving

Once her diarrhea has resolved, what additional counseling would you provide for Sally as the most appropriate next step in her treatment?

A. She should restart abemaciclib with no change to dose or schedule, increasing the use of antidiarrheal medication
B. She should restart abemaciclib with a dose reduction and continue antidiarrheals as needed
C. She should switch from abemaciclib to ribociclib due to the emergent toxicity
D. She should stop adjuvant CDK4/6 inhibitor and continue on endocrine monotherapy

2.

A 56-yr-old woman with HR+/HER2- metastatic breast cancer has been taking ribociclib with an aromatase inhibitor for 2 mo. At a follow-up visit, she reports ongoing fatigue and nausea and admits that she has missed several doses of ribociclib due to her symptoms. Laboratory values are within normal limits. In your current practice, how would you counsel this patient to improve her treatment adherence?

A. Counsel her to double dosing if she misses a dose
B. Encourage her to stop ribociclib until the fatigue improves
C. Recommend taking ribociclib at night with a light snack
D. Suggest switching to abemaciclib as she may tolerate it better

3.

A 72-yr-old with HR+/HER2- metastatic breast cancer is taking abemaciclib plus fulvestrant. At her 1-mo follow-up, she says she feels overwhelmed by the number of medications she’s taking and is also concerned about the out-of-pocket cost of her cancer treatment. She is thinking about stopping therapy. In your current practice, how would you counsel this patient?

A. Ask which medications feel burdensome and suggest specialty pharmacy support
B. Reassure her that feeling overwhelmed is normal and advise continuing treatment
C. Recommend a reduction in the dose of abemaciclib to reduce burden and cost
D. Recommend delaying the next cycle until insurance coverage is clarified

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The APP’s Guide to Patient-Centered Management of CDK4/6 Inhibitor Therapy for HR+/HER2- Breast Cancer

Elizabeth Diaz, PA-C

Julia LaBarbera, MSN, RN, AGACNP-BC

Pretest

Please answer the questions below.

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