Test your knowledge of treatment adherence in early-stage breast cancer

According to the NATALEE trial, patients with HR+ HER2- breast cancer benefit from taking adjuvant ribociclib with endocrine treatment for 3 years if:

They have node positive breast cancer

They have a T2 or higher breast cancer

They have N0 disease with grade 3 or grade 2 tumors with any of the following criteria: Ki67 >20%, Oncotype DX Breast Recurrence Score >26, or are categorized as high risk via Prosigna/PAM20, MammaPrint, or EndoPredict EPclin Risk Score

All of the above

Endocrine therapy in the NATALEE included:

Goserelin for premenopausal women and men

A non-steroidal aromatase inhibitor (letrozole or anastrozole)

Tamoxifen

Both A and B

The package insert for ribociclib recommends: Monitor liver function tests (LFTs) before initiating treatment. Monitor LFTs every 2 weeks for the first 2 cycles, at the beginning of each subsequent 4 cycles, and as clinically indicated. What level of AST and ALT (without bilirubin elevation) warrants ribociclib to be held?

Grade 2, which is an AST or ALT > 3.0 - 5.0 x ULN if baseline was normal; > 3.0 - 5.0 x baseline if baseline was abnormal

Grade 3, which is AST or ALT defined as > 5-20 times the upper limit of normal when baseline values are normal, or > 5-20 times baseline when baseline values are abnormal

Both A and B

Ribociclib can cause QTcF prolongation. What are the recommendations for monitoring a patient’s EKG while on ribociclib?

Monitor electrocardiograms (ECGs) prior to initiation of treatment with ribociclib. Repeat ECGs at approximately Day 14 of the first cycle, and as clinically indicated

Monitor electrocardiograms (ECGs) with each cycle