Division of Medical Oncology, Department of Medicine, Faculty of Medicine, King Chulalongkorn Memorial Hospital and Chulalongkorn University, Bangkok, Thailand.
Cancer Rep (Hoboken). 2022 Aug;5(8):e1575. doi: 10.1002/cnr2.1575. Epub 2021 Nov 5.
Ribociclib, one of the cyclin-dependent kinases (CDK) 4 and 6 inhibitors, in combination with endocrine therapies has been approved in the treatment of hormonal receptor positive, HER-2 negative metastatic breast cancer worldwide. Long-term usage of ribociclib with concomitant drugs, potential drug-drug interaction may develop which can limit the therapeutic value of CDK4/6 inhibitor.
A 62-year-old with history of non-insulin dependent diabetic, dyslipidemia, and essential hypertension was diagnosed with HR-positive, HER-2 negative metastatic breast cancer and treated with fulvestrant plus ribociclib. Four weeks after administration, elevated serum creatinine was observed, and then severe lactic acidosis with acute respiratory failure was subsequently reported. Ribociclib and fulvestrant were temporarily discontinued. Three days after renal replacement therapy, her clinical was stabilized. Combination ribociclib with metformin resulted in high plasma metformin levels and dangerous consequences. Hence, special precaution should be considered during concomitant treatment with sensitive transporter substrates.
Metformin associated lactic acidosis may potentially occur after combination with ribocilib, an uncommon but lethal complication from the interaction of these drugs, especially in patients who had preexisting renal impairment.
瑞博西利（ribociclib）是一种细胞周期蛋白依赖性激酶（CDK）4 和 6 抑制剂，与内分泌治疗联合应用已在全球范围内批准用于治疗激素受体阳性、HER-2 阴性转移性乳腺癌。瑞博西利与伴随药物长期联合使用，可能会发生潜在的药物相互作用，从而限制 CDK4/6 抑制剂的治疗价值。
一位 62 岁的女性，患有非胰岛素依赖型糖尿病、血脂异常和原发性高血压，被诊断为 HR 阳性、HER-2 阴性转移性乳腺癌，并接受氟维司群加瑞博西利治疗。给药 4 周后，观察到血清肌酐升高，随后报告严重乳酸酸中毒伴急性呼吸衰竭。瑞博西利和氟维司群暂时停药。肾替代治疗 3 天后，她的病情稳定下来。瑞博西利和二甲双胍合用会导致二甲双胍的血药浓度升高，产生危险的后果。因此，在与敏感转运体底物同时治疗时应考虑特殊的预防措施。
与瑞博西利联合使用可能会发生二甲双胍相关乳酸酸中毒，这是这些药物相互作用的一种罕见但致命的并发症，尤其是在存在预先存在的肾功能损害的患者中。
