Department of Internal Medicine, Division of Medical Oncology, Başakşehir Çam and Sakura City Hospıtal, Istanbul, Türkiye.
J Oncol Pharm Pract. 2023 Sep;29(6):1529-1532. doi: 10.1177/10781552231180463. Epub 2023 Jun 12.
Cyclin-dependent kinase (CDK) 4/6 inhibitors are widely used in combination with aromatase inhibitors or fulvestrant for the treatment of locally advanced or metastatic hormone receptor-positive (HR+), human epidermal growth factor 2-negative (HER2-) breast cancer. Hematological toxicities (e.g. neutropenia, thrombocytopenia, anemia, lymphopenia, or febrile neutropenia), infections, decreased appetite, exhaustion, headache, dizziness, cough, nausea, vomiting, diarrhea, alopecia, rash, increased alanine aminotransferase and aspartate aminotransferase levels, and QT interval prolongation are frequent side effects associated with the use of CDK 4/6 inhibitors. However, to our knowledge, no case of hallucination associated with CDK 4/6 inhibitor use has been described in the English-language literature.
We report a case of a 72-year-old woman with metastatic breast cancer who developed visual hallucinations after receiving ribociclib, a CDK 4/6 inhibitor, and letrozole for 3 days. Cranial imaging and blood tests did not reveal the cause of the hallucinations.
The visual hallucinations completely resolved within 4 days after the ribociclib treatment was terminated. The patient received only letrozole for 2 weeks, and ribociclib treatment was restarted 2 weeks later. Visual hallucinations recurred on the third day of treatment, and ribociclib treatment was discontinued again. The patient recovered completely from visual hallucinations 4 days after discontinuation. Subsequently, treatment was continued with letrozole and palbociclib, another CDK 4/6 inhibitor. Hallucinations did not recur during follow-up.
To our knowledge, this is the first reported case of hallucinations caused by ribociclib; notably, it shows that symptoms may develop in the early stage of treatment.
细胞周期蛋白依赖性激酶（CDK）4/6 抑制剂广泛与芳香酶抑制剂或氟维司群联合用于治疗局部晚期或转移性激素受体阳性（HR+）、人表皮生长因子 2 阴性（HER2-）乳腺癌。血液学毒性（如中性粒细胞减少症、血小板减少症、贫血、淋巴细胞减少症或发热性中性粒细胞减少症）、感染、食欲下降、乏力、头痛、头晕、咳嗽、恶心、呕吐、腹泻、脱发、皮疹、丙氨酸氨基转移酶和天冬氨酸氨基转移酶水平升高以及 QT 间期延长是与 CDK 4/6 抑制剂使用相关的常见副作用。然而，据我们所知，在英语文献中尚未描述与 CDK 4/6 抑制剂使用相关的幻觉病例。
我们报告了一例 72 岁女性转移性乳腺癌患者，在接受 CDK 4/6 抑制剂瑞博西利和来曲唑治疗 3 天后出现视觉幻觉。头颅成像和血液检查未发现幻觉的原因。
瑞博西利治疗停止后 4 天内，视觉幻觉完全消失。患者仅接受来曲唑治疗 2 周，2 周后重新开始瑞博西利治疗。治疗第 3 天再次出现视觉幻觉，再次停止瑞博西利治疗。停药 4 天后，患者完全从视觉幻觉中恢复。随后，继续使用来曲唑和另一种 CDK 4/6 抑制剂帕博西利进行治疗。在随访期间未再出现幻觉。
据我们所知，这是首例由瑞博西利引起的幻觉病例报告；值得注意的是，它表明症状可能在治疗早期出现。
