{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T02:11:25Z","timestamp":1787019085816,"version":"build-2736575974"},"reference-count":18,"publisher":"SAGE Publications","issue":"7","license":[{"start":{"date-parts":[[2025,5,13]],"date-time":"2025-05-13T00:00:00Z","timestamp":1747094400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["J Oncol Pharm Pract"],"published-print":{"date-parts":[[2025,10]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Cyclin Dependent Kinase (CDK) 4\/6 inhibitors are changing the landscape of breast cancer treatment. These medications are generally well-tolerated, but incidences of hepatotoxicity have been reported in the literature.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case Report<\/jats:title>\n                    <jats:p>In this case, we present a 36-year-old Caucasian female who was diagnosed with hormone-receptor (HR) positive, human epidermal growth factor receptor 2 (HER2) negative metastatic breast cancer who initiated first line treatment with an aromatase inhibitor and a cyclin-dependent kinase (CDK) 4\/6 inhibitor, ribociclib. Following treatment initiation, she experienced grade 4 hepatoxicity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Management and Outcome<\/jats:title>\n                    <jats:p>Ribociclib was discontinued due to probable cause of hepatotoxicity based on a Naranjo score of 7. Once her liver enzymes resolved to grade 1 toxicity, she was transitioned to another CDK 4\/6 inhibitor, palbociclib. The patient has remained on palbociclib for 1 year of treatment with normalization of her liver function enzymes and stable disease.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>This case presents a successful rechallenge of an alternative CDK 4\/6 inhibitor after grade 4 ribociclib-induced hepatotoxicity and reviews similar cases of ribociclib-induced hepatoxicity and management strategies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/10781552251340613","type":"journal-article","created":{"date-parts":[[2025,5,13]],"date-time":"2025-05-13T03:53:17Z","timestamp":1747108397000},"page":"1174-1178","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":4,"title":["Rechallenge of an alternative CDK 4\/6 inhibitor after hepatotoxicity in the treatment of hormone-positive metastatic breast cancer"],"prefix":"10.1177","volume":"31","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-9979-4961","authenticated-orcid":false,"given":"Kasey","family":"Jackson","sequence":"first","affiliation":[{"name":"Medical University of South Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kiera","family":"Roubal","sequence":"additional","affiliation":[{"name":"Medical University of South Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher","family":"Rangel","sequence":"additional","affiliation":[{"name":"Medical University of South Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frank","family":"Brescia","sequence":"additional","affiliation":[{"name":"Medical University of South Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2025,5,13]]},"reference":[{"key":"e_1_3_2_2_2","unstructured":"National Comprehensive Cancer Network. Breast Cancer (Version 6.2024). https:\/\/www.nccn.org\/professionals\/physician_gls\/pdf\/breast.pdf. Accessed November 19 2024."},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(18)30292-4"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2305488"},{"key":"e_1_3_2_5_2","unstructured":"Kisqali (ribociclib) [prescribing information]. East Hanover NJ: Novartis Pharmaceuticals Corp; September 2024."},{"key":"e_1_3_2_6_2","unstructured":"LiverTox: Clinical and Research Information on Drug-Induced Liver Injury [Internet]. Bethesda (MD): National Institute of Diabetes and Digestive and Kidney Diseases; 2012-. Adverse Drug Reaction Probability Scale (Naranjo) in Drug Induced Liver Injury. [Updated 2019 May 4]. Available from: https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK548069\/."},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1810527"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2114663"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.annonc.2024.04.013"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1080\/14737140.2021.1852934"},{"key":"e_1_3_2_11_2","first-page":"3987","article-title":"Abemaciclib combined with endocrine therapy for the adjuvant treatment of HR+, HER2-node-positive, high-risk, early breast cancer (monarchE)","volume":"38","author":"Johnston SRD","year":"2023","unstructured":"Johnston SRD, Harbeck N, Hegg R, et al. Abemaciclib combined with endocrine therapy for the adjuvant treatment of HR+, HER2-node-positive, high-risk, early breast cancer (monarchE). Lancet 2023; 38: 3987\u20133998.","journal-title":"Lancet"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2305488"},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.1016\/S1590-8658(22)00444-3"},{"key":"e_1_3_2_14_2","doi-asserted-by":"publisher","DOI":"10.1177\/10781552231154009"},{"key":"e_1_3_2_15_2","doi-asserted-by":"publisher","DOI":"10.1177\/10781552231208390"},{"key":"e_1_3_2_16_2","doi-asserted-by":"publisher","DOI":"10.1111\/tbj.13532"},{"key":"e_1_3_2_17_2","article-title":"Hepatotoxicity after CDK 4\/6 inhibitor initiation in the treatment of hormone-positive metastatic breast cancer","volume":"15","author":"Wani K","year":"2023","unstructured":"Wani K, Patel K, Dabak V. Hepatotoxicity after CDK 4\/6 inhibitor initiation in the treatment of hormone-positive metastatic breast cancer. Cureus 2023; 15: e40871.","journal-title":"Cureus"},{"key":"e_1_3_2_18_2","doi-asserted-by":"publisher","DOI":"10.1177\/10781552231174593"},{"key":"e_1_3_2_19_2","doi-asserted-by":"publisher","DOI":"10.1177\/10781552211027931"}],"container-title":["Journal of Oncology Pharmacy Practice"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/10781552251340613","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/10781552251340613","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/10781552251340613","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,2]],"date-time":"2026-05-02T02:31:10Z","timestamp":1777689070000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/10781552251340613"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,5,13]]},"references-count":18,"journal-issue":{"issue":"7","published-print":{"date-parts":[[2025,10]]}},"alternative-id":["10.1177\/10781552251340613"],"URL":"https:\/\/doi.org\/10.1177\/10781552251340613","relation":{},"ISSN":["1078-1552","1477-092X"],"issn-type":[{"value":"1078-1552","type":"print"},{"value":"1477-092X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,5,13]]}}}