Clinician discussion draft. Complete the approved local consent process. Entries remain in this page’s memory and clear on reload; do not enter names, MRNs or dates of birth.

NCCP 00525 · version 6

Ribociclib + endocrine therapy · metastatic

The usual metastatic starting dose is ribociclib 600 mg once daily on Days 1–21 followed by Days 22–28 off. Continue the prescribed AI daily or fulvestrant on its own injection schedule; add ovarian suppression when indicated. Continue while beneficial and tolerated.

Purpose, setting and alternatives

Ribociclib with an aromatase inhibitor or fulvestrant aims to control advanced HR-positive/HER2-negative breast cancer. The exact endocrine partner depends on previous treatment and menopausal status. HR-positive/HER2-negative locally advanced or metastatic disease with an AI or fulvestrant in the exact NCCP indication. NCCP page 1 and page 2 do not fully align on menopause and previous advanced-disease treatment; preserve consultant reconciliation.

Individual aim, expected benefit, uncertainty and planned duration

Reasonable alternatives, including not proceeding with this regimen

Material risks and support

Low white cells and infection
Liver injury / abnormal blood tests
QT prolongation / heart-rhythm problems
Nausea, fatigue and hair thinning
Rare serious lung or skin reactions
Hot flushes, joint pain and fatigue
Bone loss with AI / ovarian suppression
Injection-site discomfort with fulvestrant
Drug-specific liver and other effects

Discuss the treatment aim, alternatives, benefit and uncertainty, important medicine-specific risks, reproductive precautions, symptom support and planned duration. Confirm the endocrine partner and any ovarian-suppression plan. The timeline does not authorise a restart or certify clinical review.

Individual risks, interactions, menopause and fertility / contraception discussion

Monitoring and understanding

FBC, renal and liver profile, potassium, calcium, magnesium and phosphorus. ECG before initiation; QTcF must be below 450 ms. Correct electrolyte abnormalities and review QT/CYP3A interactions. Confirm endocrine partner, menopause/ovarian suppression, prior treatment and the NCCP indication/eligibility discrepancy. FBC, renal and liver profile every two weeks for cycles 1–2, then before cycles 3–6, then as clinically indicated. Electrolytes before each of the first six cycles, then as clinically indicated; correct abnormalities. Repeat ECG around Day 14 of cycle 1, then as clinically indicated. Increase liver monitoring for grade 2 or worse abnormalities. Review fever, jaundice, palpitations/fainting, pulmonary and severe skin symptoms; response imaging follows the advanced-disease plan.

Review the whole-treatment map togetherPatient priorities, questions, understanding and follow-up

Clinician review / date; no patient identifiers

Consent can be reconsidered. This draft does not establish capacity, consent or treatment authorisation.

Sources and review

The NCCP regimen supplies the treatment rules. Separate guidelines supply the longer-term monitoring recommendations, with their qualifications retained.

Source reconciled; independent clinical, pharmacy and patient/PPI review pending