Shrestha P*, George M, and Rai S
CDK inhibitors have demonstrated a higher efficacy compared to hormone
therapy alone for advanced Hormone receptor-positive (HR+)/HER2 negative
breast cancer and also have a manageable toxicity profile. Specific severe
dermatological reaction to CDK inhibitors has been rarely reported. We are
reporting a case of severe skin reaction more than six months after the initia-
tion of Ribociclib requiring treatment cessation of Ribociclib.
We are reporting a case of a 46-year-old lady diagnosed with locally ad-
vanced hormone receptor-positive HER2 negative inflammatory breast can-
cer in November 2016 associated with pleural based masses and prominent
retroperitoneal lymph nodes. She was commenced on Tamoxifen but devel-
oped a solitary brain lesion in cerebellum. She underwent stereotactic radio-
therapy and was commenced on Ribociclib and Anastrozole. On the second
week of the 8th cycle of Ribociclib, she developed a rash on her breasts and
forearms. The rash spread to her forehead, face, arms, chest, back and lower
limbs. There was no definite mucosal involvement and had mild crusting on
her lips but no ulceration. She was also systemically well and did not have
any active mucosal lesions at the time of review. This was thought to be con-
sistent with erythema multiform/SJS like reaction as per dermatology review.
It was determined to be related to Ribociclib due to the temporal association.
She had resolving skin changes with residual hyperpigmentation after eight
weeks of cessation of Ribociclib without systemic steroid therapy.
This case emphasizes the need for ongoing vigilance even beyond first 6
months of commencing Ribociclib. It also highlights that some of the pa-
tients with severe skin reactions can be managed with only topical steroid
treatment.