TMBS E99: Dr Denise Yardley, Good News for Cancer Patients

POSITIVE NEWS CONTINUES TO EMERGE FOR ADVANCED BREAST CANCER PATIENTS

KISQALI EXPLORATORY SUBGROUP ANALYSIS FROM MONALEESA-3 AND MONALEESA-7, RESULTS ADD TO BODY OF OVERALL SURVIVAL EVIDENCE

Denise Yardley, MD, Principal Investigator, Sarah Cannon Research Institute

There are approximately 155,000 individuals in the US are living with metastatic breast cancer.

Up to 11% of new breast cancer cases are initially stage IV or metastatic.

Nearly 30% of women initially diagnosed with the early-stage disease will ultimately develop metastatic lesions, often months or even years later. 

And as of 2017, in the United States, nearly 1 in 7 women with metastatic BC were younger than 50. ……Denise Yardley, MD, is the Principal Investigator for the Sarah Cannon Research Institute.

Indication

KISQALI® (ribociclib) is a prescription medicine used in combination with:
• an aromatase inhibitor to treat pre/perimenopausal or postmenopausal women with hormone receptor (HR)-positive, human epidermal growth factor receptor 2 (HER2)-negative breast cancer that has spread to other parts of the body (metastatic), as the first endocrine-based therapy; or
• fulvestrant to treat postmenopausal women with HR-positive, HER2-negative metastatic breast cancer as the first endocrine-based therapy or with disease progression following endocrine therapy. It is not known if KISQALI is safe and effective in children.

IMPORTANT SAFETY INFORMATION

What is the most important information I should know about KISQALI?

KISQALI may cause serious side effects, including:

Lung problems. KISQALI may cause severe or life-threatening inflammation of the lungs during treatment that may lead to death. Tell your health care provider right away if you have any new or worsening symptoms, including:

trouble breathing or shortness of breath

cough with or without mucus
chest pain

Heart rhythm problems (QT prolongation). KISQALI can cause a heart problem known as QT prolongation. This condition can cause an abnormal heartbeat and may lead to death. Your health care provider should check your heart and do blood tests before and during treatment with KISQALI. Tell your health care provider right away if you have a change in your heartbeat (a fast or irregular heartbeat), or if you feel dizzy or faint.

 Liver problems (hepatobiliary toxicity). KISQALI can cause serious liver problems. Your health care provider should do blood tests to check your liver before and during treatment with KISQALI. Tell your health care provider right away if you get any of the following signs and symptoms of liver problems:

yellowing of your skin or the whites of your eyes (jaundice)
dark or brown (tea-colored) urine
feeling very tired
loss of appetite
pain on the right side of your stomach area (abdomen)

bleeding or bruising more easily than normal

 Low white blood cell counts (neutropenia). Low white blood cell counts are very common when taking KISQALI and may result in infections that may be severe. Your health care provider should check your white blood cell counts before and during treatment with KISQALI. Tell your health care provider right away if you have signs and symptoms of low white blood cell counts or infections such as fever and chills.

Your health care provider may tell you to decrease your dose, temporarily stop, or completely stop taking KISQALI if you develop certain serious side effects during treatment with KISQALI. 

 What should I tell my health care provider before taking KISQALI?

Before you take KISQALI, tell your health care provider if you:

have any heart problems, including heart failure, irregular heartbeats, and QT prolongation
have ever had a heart attack
have a slow heartbeat (bradycardia)
have problems with the amount of potassium, calcium, phosphorus, or magnesium in your blood
have fever, chills, or any other signs or symptoms of infection

have liver problems 
have any other medical conditions
are pregnant, or plan to become pregnant. KISQALI can harm your unborn baby

If you are able to become pregnant, your health care provider should do a pregnancy test before you start treatment with KISQALI.
Females who are able to become pregnant and who take KISQALI should use effective birth control during treatment and for at least 3 weeks after the last dose of KISQALI.

Talk to your health care provider about birth control methods that may be right for you during this time.
If you become pregnant or think you are pregnant, tell your health care provider right away.

are breastfeeding or plan to breastfeed. It is not known if KISQALI passes into your breast milk. Do not breastfeed during treatment with KISQALI and for at least 3 weeks after the last dose of KISQALI

Tell your health care provider about all of the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements. KISQALI and other medicines may affect each other, causing side effects. Know the medicines you take. Keep a list of them to show your health care provider or pharmacist when you get a new medicine.

What should I avoid while taking KISQALI? 

Avoid eating grapefruit and avoid drinking grapefruit juice during treatment with KISQALI since these may increase the amount of KISQALI in your blood.

The most common side effects of KISQALI include:

neutropenia	vomiting
nausea	hair loss
infections	headache
fatigue	constipation
diarrhea	rash
leukopenia	cough

KISQALI may cause fertility problems if you are male and take KISQALI. This may affect your ability to father a child. Talk to your health care provider if this is a concern for you.

Tell your health care provider if you have any side effect that bothers you or that does not go away.

These are not all of the possible side effects of KISQALI. For more information, ask your health care provider or pharmacist. Call your doctor for medical advice about side effects. You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch, or call 1-800-FDA-1088.

Please see accompanying full Prescribing Information.

References

Yardley, Denise, A. et. al. Overall survival (OS) in patients (pts) with advanced breast cancer (ABC) with visceral metastases (Mets), including those with liver Mets, treated with ribociclib (RIB) plus endocrine therapy (ET) in the MONALEESA (ML) -3 and -7 trials. Presented at the American Society of Clinical Oncology (ASCO) meeting (Abstract #1054).

Wang, R., Zhu, Y., Liu, X. et al. The Clinicopathological features and survival outcomes of patients with different metastatic sites in stage IV breast cancer. BMC Cancer 19, 1091 (2019).