Names and pronunciation
(pal-boe-sye′klib) Ibrance
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Drug reference
(pal-boe-sye′klib) Ibrance
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Func. class.: Antineoplastic
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Chem. class.: Signal transduction inhibitor, kinase inhibitor
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ACTION: Inhibits progression of the cell cycle from G1 into S phase, decreased proliferation of ER-positive breast cancer cell lines. When combined with antiestrogen therapy (letrozole), decreases retinoblastoma protein (Rb) phosphorylation, reducing E2F expression and signaling and increasing growth arrest
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USES: Treatment of estrogen receptor (ER)–positive, HER2-negative advanced breast cancer in postmenopausal women, in combination with letrozole as initial endocrine-based therapy
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CONTRAINDICATIONS: Hyper sensitivity, pregnancy, lactation Precautions: children, fungal/viral infection, infants, infertility, neutropenia, testicular failure, thromboembolic disease
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SIDE EFFECTS CNS: Weakness, fever, fatigue EENT: Stomatitis, oral ulceration, glos- sitis, pharyngitis, sinusitis, epistaxis GI: Vomiting, nausea, anorexia, diarrhea INTEG: Alopecia, rash HEMA: Thrombocytopenia, neutropenia, leukopenia, lymphopenia, anemia MISC: Peripheral neuropathy, infection, pulmonary embolism, thromboembolism
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INTERACTIONS Avoid use with CYP3A inhibitors and inducers Drug/Herb • Avoid use with St. John’s wort Drug/Food • Avoid use with grapefruit juice
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DOSAGE AND ROUTES Hormone receptor (HR)-positive, HER2-negative advanced or meta- static breast cancer • Adult females: PO 125 mg daily with food × 21 days, followed by 7 days off, repeat q28 days, given with letrozole 2.5 mg/day; give continuously through each cycle
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Available forms: Caps 75, 100, 125 mg
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Administer: • Give at the same time of the day with food and letrozole, capsules should be swallowed whole; do not cut, open, chew, do not use if capsule is not intact
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Assess: • Pulmonary embolism/thromboem- bolic events: dyspnea/shortness of breath, chest pain, arm or leg swelling, sudden numbness or weakness, severe headache or confusion, or problems with vision, speech, or balance • Blood dyscrasias: CBC/differential prior to and q2wk first 2 cycles, then be- fore each cycle or if change in symptoms • GI status: nausea, diarrhea, anorexia, weight loss • Body image: hair loss, loss of weight • Pregnancy: product can cause fetal harm; identify if the patient is pregnant or if pregnancy is planned
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Evaluate: Therapeutic response: decreased progression of disease
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CLINICAL CONSIDERATIONS
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Patient and caregiver information: • That laboratory testing will be needed during treatment • Do not take with grapefruit juice • Pulmonary/thromboembolic events: to seek medical attention if dyspnea/shortness of breath, chest pain, arm or leg swelling, sudden numbness or weakness, severe headache or confusion, or problems with P vision, speech, or balance develop • To take as prescribed, not to double or skip dose, review “Patient Information Sheet” • To notify provider of infection • To discuss all OTC, Rx, herbals, sup- plements taken • Identify if pregnancy is planned or sus- pected. Discuss the need for contracep- tion due to possible fetal harm; avoid breastfeeding
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PHARMACOKINETICS 85% protein bound, elimination half-life was 24-34 hr, metabolized by CYP3A, peak 6-12 hr
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• Adult females: PO 125 mg daily with food × 21 days, followed by 7 days off, repeat q28 days, given with letrozole 2.5 mg/day; give continuously through each cycle
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