{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,3]],"date-time":"2026-11-03T17:41:59Z","timestamp":1793727719966,"version":"4.6.1"},"reference-count":18,"publisher":"SAGE Publications","issue":"6","license":[{"start":{"date-parts":[[2025,5,19]],"date-time":"2025-05-19T00:00:00Z","timestamp":1747612800000},"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>Background<\/jats:title>\n                    <jats:p>Cyclin-dependent kinase 4 and 6 (CDK4\/6) inhibitors, such as ribociclib, are the cornerstone of treatment for estrogen receptor-positive (ER+), human epidermal growth factor receptor 2-negative (HER2-) metastatic breast cancer. However, ribociclib is known to cause hepatotoxicity, and the role of other dietary supplements in this process is not well understood.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case Presentation<\/jats:title>\n                    <jats:p>\n                      A 47-year-old woman with metastatic breast cancer experienced grade III hepatotoxicity shortly after starting ribociclib. Despite discontinuing the drug, transaminase levels remained elevated. Using the the Roussel Uclaf Causality Assessment Method (RUCAM), a probable drug-induced liver injury was identified (score: 6). Upon disclosure of concurrent use of a fenugreek-based supplement, the revised RUCAM score dropped to 4. Further anamnesis revealed concurrent intake of a fenugreek-based supplement, prompting a revised RUCAM score of 4. The Naranjo Adverse Drug Reaction Probability Scale also indicated a\n                      <jats:italic toggle=\"yes\">possible<\/jats:italic>\n                      association (score: 4). In contrast, the Drug Interaction Probability Scale (DIPS) scored 5, suggesting a\n                      <jats:italic toggle=\"yes\">probable<\/jats:italic>\n                      herb-drug interaction between ribociclib and fenugreek.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Management and Outcome<\/jats:title>\n                    <jats:p>Transaminase levels gradually returned to normal within eight weeks of stopping ribociclib and four weeks after discontinuing the fenugreek supplement. The patient was counseled to avoid herbal supplements and initiated on palbociclib as an alternative CDK4\/6 inhibitor. Liver function remained stable with no recurrent hepatotoxicity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>Fenugreek modulates CYP3A4, which metabolizes ribociclib. This case highlights underrecognized herb-drug interactions in oncology.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/10781552251340911","type":"journal-article","created":{"date-parts":[[2025,5,19]],"date-time":"2025-05-19T15:25:56Z","timestamp":1747668356000},"page":"1018-1023","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":5,"title":["Ribociclib-Induced hepatotoxicity exacerbated by fenugreek supplement use: A case report"],"prefix":"10.1177","volume":"31","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-6899-1031","authenticated-orcid":false,"given":"Yousra","family":"Al Harrak","sequence":"first","affiliation":[{"name":"Department of Medical Oncology, National Institute of Oncology, CHU Ibn Sina, Rabat, Morocco"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sihame","family":"Lkhoyaali","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, National Institute of Oncology, CHU Ibn Sina, Rabat, Morocco"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-6996-2709","authenticated-orcid":false,"given":"Oumaima","family":"Lamsyah","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, National Institute of Oncology, CHU Ibn Sina, Rabat, Morocco"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marie Monique","family":"Tine","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, National Institute of Oncology, CHU Ibn Sina, Rabat, Morocco"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hafsa","family":"Bechar","sequence":"additional","affiliation":[{"name":"Pharmacovigilance unit, National Institute of Oncology, CHU Ibn Sina, Rabat, Morocco"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ghita","family":"Benabdallah","sequence":"additional","affiliation":[{"name":"Anti Poison and Pharmacovigilance Centre of Morocco, Rabat, Morocco"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Houda","family":"Sefiani","sequence":"additional","affiliation":[{"name":"Anti Poison and Pharmacovigilance Centre of Morocco, Rabat, Morocco"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saber","family":"Boutayeb","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, National Institute of Oncology, CHU Ibn Sina, Rabat, Morocco"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hassan","family":"Errihani","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, National Institute of Oncology, CHU Ibn Sina, Rabat, Morocco"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2025,5,19]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.annonc.2021.09.019"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1609709"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1097\/CAD.0000000000000845"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1093\/annonc\/mdx158"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1155\/2013\/302426"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ctrv.2016.03.002"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.3389\/fphar.2019.01235"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.4103\/0253-7613.165179"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1080\/14737140.2021.1852934"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1080\/0284186X.2020.1853228"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.1177\/10781552211027931"},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.1111\/tbj.13532"},{"key":"e_1_3_2_14_2","doi-asserted-by":"publisher","DOI":"10.3389\/fonc.2023.1256783"},{"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":"10.1177\/10781552231154009"},{"key":"e_1_3_2_17_2","first-page":"180","article-title":"Effect of trigonella foenum-graecum l. @ on metabolic activity of CYP2D6 and CYP3A4","volume":"22","author":"Al-Jenoobi FI","year":"2015","unstructured":"Al-Jenoobi FI, Al-Thukair AA, Alam MA, et al. Effect of trigonella foenum-graecum l. @ on metabolic activity of CYP2D6 and CYP3A4. Forsch Komplementmed 2015; 22: 180\u2013184.","journal-title":"Forsch Komplementmed"},{"key":"e_1_3_2_18_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.fct.2016.08.003"},{"key":"e_1_3_2_19_2","doi-asserted-by":"publisher","DOI":"10.3389\/fonc.2022.1026434"}],"container-title":["Journal of Oncology Pharmacy Practice"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/10781552251340911","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/10781552251340911","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/10781552251340911","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\/10781552251340911"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,5,19]]},"references-count":18,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2025,10]]}},"alternative-id":["10.1177\/10781552251340911"],"URL":"https:\/\/doi.org\/10.1177\/10781552251340911","relation":{},"ISSN":["1078-1552","1477-092X"],"issn-type":[{"value":"1078-1552","type":"print"},{"value":"1477-092X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,5,19]]}}}