Practical Care Coordination, Adherence, and Toxicity Management

The faculty explore the practical and logistical dimensions of delivering adjuvant CDK4/6 inhibitor therapy, including prescribing, care team coordination, and the identification of patients at higher risk of non-adherence. The discussion highlights the contributions of pharmacists, nurses, and advanced practice providers in patient teaching and early follow-up, as well as strategies for synchronizing laboratory monitoring and injections to minimize clinic burden for patients returning to work and daily life. Attention then turns to the principal toxicities associated with these agents, including gastrointestinal effects with abemaciclib, neutropenia across the class, and hepatic enzyme abnormalities associated with ribociclib. The panel reviews approaches to monitoring and management, including the use of a stepwise dose escalation strategy at initiation and the role of dose reduction in improving tolerability without presumed loss of efficacy. The conversation closes by considering how evolving genomic data may lead to more patients receiving endocrine therapy and CDK4/6 inhibition without chemotherapy.