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.
Oral treatment with a planned rest weekRibociclib 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.
Ribociclib blocks CDK4 and CDK6, proteins that help cells move through the cycle of division. Endocrine therapy reduces the hormone signal that can drive HR-positive breast cancer.
Keep blood and ECG appointments. Fever, jaundice, fainting, palpitations, severe rash or new breathlessness need prompt advice.
An aromatase inhibitor (AI) lowers oestrogen production; fulvestrant blocks and reduces oestrogen receptors. These are alternative endocrine partners, selected by the team. Ovarian suppression is needed in pre/perimenopausal patients.
The endocrine medicine continues during the ribociclib week off. Report troublesome joint, menopausal or injection-site symptoms.
This is a visual orientation, not a prediction of your personal cycle. It shows when some effects often emerge and which effects are not tied to a particular day.
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.
There are no guaranteed “safe days”. Fever, shivers or suddenly feeling unwell require immediate contact. Serious symptoms override the timeline or diary.
Columns show sequence and general intervals, not equal periods or booked appointments. The team confirms who arranges each test, who reviews results and who authorises treatment or restart.
| Check | Before first dose | Cycles 1–2 | Cycles 3–6 | Later treatment | Completion / change |
|---|---|---|---|---|---|
| Ribociclib and endocrine partner | Confirm metastatic 600 mg / AI or fulvestrant plan | Days 1–21 on; Days 22–28 off; fulvestrant loading visits if chosen | Repeat if cleared; endocrine partner continues | While beneficial and tolerated | Review endocrine continuation separately |
| Blood counts / renal / liver | Baseline profiles | Every two weeks in both cycles | Before each cycle | As clinically indicated; more often if abnormal | Follow abnormalities before restart or after stopping |
| ECG / heart rhythm | Baseline ECG; check QTcF eligibility | Repeat around cycle 1 Day 14 | Further ECG when clinically indicated | Repeat for symptoms, QT change or interacting medicines | No automatic restart after a QT-related hold |
| Electrolytes | Potassium, calcium, magnesium and phosphorus | Before each cycle; correct abnormalities | Before each cycle through cycle 6 | As clinically indicated | Review unresolved abnormalities |
| Bone / endocrine health | Assess AI/OFS bone and menopausal risks | Support symptoms and adherence | AI/OFS and any injections follow their own plan | Repeat bone assessment according to risk | Longer endocrine and bone plan continues |
| Cancer response | Baseline disease assessment | Assess new symptoms promptly | Imaging according to consultant plan | Continue response and symptom review | Progression prompts new treatment decision |
HR-positive / HER2-negative metastatic breast cancer
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.
On a small screen, swipe the map sideways. The checks below give the same timing in words.
| Care / check | Before first dose | Cycles 1–2 | Cycles 3–6 | Later treatment | Completion / change |
|---|---|---|---|---|---|
| Ribociclib and endocrine partnerNCCP 00525 · SMPC | Confirm metastatic 600 mg / AI or fulvestrant plan | Days 1–21 on; Days 22–28 off; fulvestrant loading visits if chosen | Repeat if cleared; endocrine partner continues | While beneficial and tolerated | Review endocrine continuation separately |
| Blood counts / renal / liverNCCP 00525 · SMPC | Baseline profiles | Every two weeks in both cycles | Before each cycle | As clinically indicated; more often if abnormal | Follow abnormalities before restart or after stopping |
| ECG / heart rhythmNCCP 00525 · SMPC | Baseline ECG; check QTcF eligibility | Repeat around cycle 1 Day 14 | Further ECG when clinically indicated | Repeat for symptoms, QT change or interacting medicines | No automatic restart after a QT-related hold |
| ElectrolytesNCCP 00525 · SMPC | Potassium, calcium, magnesium and phosphorus | Before each cycle; correct abnormalities | Before each cycle through cycle 6 | As clinically indicated | Review unresolved abnormalities |
| Bone / endocrine healthNCCP 00525 · SMPC | Assess AI/OFS bone and menopausal risks | Support symptoms and adherence | AI/OFS and any injections follow their own plan | Repeat bone assessment according to risk | Longer endocrine and bone plan continues |
| Cancer responseNCCP 00525 · SMPC | Baseline disease assessment | Assess new symptoms promptly | Imaging according to consultant plan | Continue response and symptom review | Progression prompts new treatment decision |
Check eligibility, organ function and the exact treatment/support plan.
Ask / act: Confirm who arranges each check and who reviews it.
Sources: NCCP 00525 · SMPC
Important toxicity can begin before the first routine review.
Ask / act: Keep early appointments and use the agreed symptom-contact plan.
Sources: NCCP 00525 · SMPC
Longer-term treatment still needs clinical review.
Ask / act: Ask about symptom support, results and the next decision.
Sources: NCCP 00525 · SMPC
The targeted medicine and endocrine partner may have different stop dates.
Ask / act: Confirm each medicine and the ongoing follow-up plan.
Sources: NCCP 00525
This map does not show whether a test has been ordered, booked or completed. Do not wait for a scheduled test if you develop new symptoms.
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.
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. There is no fixed three-year stop in this metastatic regimen; the team reviews response, side effects and the next treatment decision.
Baseline tests and ongoing tests have different purposes.
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.
NCCP 00525 v6 · official regimen · EMA Kisqali current product information; checked 2026-10-25
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.
NCCP 00525 v6 · official regimen · EMA Kisqali current product information; checked 2026-10-25
Supportive medicines and the endocrine partner have their own plan.
NCCP classifies ribociclib as oral moderate–high emetic risk. The team chooses preventive or rescue antiemetics using local policy, symptoms, QT risk and drug interactions; do not reuse another regimen’s prescription.
NCCP 00525 v6 · official regimen · EMA Kisqali current product information; checked 2026-10-25
Correct abnormal potassium, calcium, magnesium and phosphate as directed. Attend the baseline and cycle 1 Day-14 ECG; fainting or palpitations need urgent advice.
NCCP 00525 v6 · official regimen · EMA Kisqali current product information; checked 2026-10-25
Keep the early two-weekly blood tests and subsequent monitoring. Report fever, shivers, jaundice or dark urine promptly.
NCCP 00525 v6 · official regimen · EMA Kisqali current product information; checked 2026-10-25
The AI or fulvestrant, and ovarian suppression when prescribed, continue on their own timetable. Discuss joint, menopausal, bone and injection-site symptoms.
NCCP 00525 v6 · official regimen · EMA Kisqali current product information; checked 2026-10-25
Avoid grapefruit and check interactions. Do not replace a missed or vomited dose. A clinical hold requires explicit instructions about which medicine stops and who authorises restart.
NCCP 00525 v6 · official regimen · EMA Kisqali current product information; checked 2026-10-25
Studies of ribociclib with hormone therapy in defined advanced-breast-cancer groups showed a survival benefit. The studies used different hormone partners and included different menopausal and prior-treatment groups. Ask which study matches your plan; the results do not set an individual time limit.
Study results describe groups with defined treatment and eligibility. Ask about your own likely benefits, important harms, alternatives and remaining uncertainty.
MONALEESA-2 final OS, Hortobagyi et al 2022 · MONALEESA-2 updated PFS, Hortobagyi et al 2018 · MONALEESA-3 updated overall-population OS, Slamon et al 2021 · MONALEESA-7 exploratory extended OS, Lu et al 2022
There is no fixed three-year stop in this metastatic regimen; the team reviews response, side effects and the next treatment decision.
The team confirms the plan for each medicine and the next review. Do not restart a clinically held treatment from this educational timeline.
NCCP 00525 v6 · official regimen · EMA Kisqali current product information; checked 2026-10-25
NCCP classifies ribociclib as oral moderate–high emetic risk. The team chooses preventive or rescue antiemetics using local policy, symptoms, QT risk and drug interactions; do not reuse another regimen’s prescription.
Correct abnormal potassium, calcium, magnesium and phosphate as directed. Attend the baseline and cycle 1 Day-14 ECG; fainting or palpitations need urgent advice.
Keep the early two-weekly blood tests and subsequent monitoring. Report fever, shivers, jaundice or dark urine promptly.
The AI or fulvestrant, and ovarian suppression when prescribed, continue on their own timetable. Discuss joint, menopausal, bone and injection-site symptoms.
Avoid grapefruit and check interactions. Do not replace a missed or vomited dose. A clinical hold requires explicit instructions about which medicine stops and who authorises restart.
Studies describe groups. Ask how closely the treatment and study population match your situation.
Your team can discuss the strength and limitations of the evidence alongside treatment risks and alternatives.
Acute Oncology Service
Ask for medical oncology
Other hospitals: use the contacts your own team provides.
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. There is no fixed three-year stop in this metastatic regimen; the team reviews response, side effects and the next treatment decision.
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.
No. This map shows general timing without personal information. Your hospital arranges actual appointments; ask who books each test and who reviews its result.
Take ribociclib once daily with or without food; swallow whole. Avoid grapefruit. If a dose is missed or vomited, do not take an extra dose; take the next scheduled dose. Confirm any clinical hold and restart with the team. The endocrine partner follows a separate prescription. A hold may affect one medicine rather than the whole combination; confirm each component.
Studies of ribociclib with hormone therapy in defined advanced-breast-cancer groups showed a survival benefit. The studies used different hormone partners and included different menopausal and prior-treatment groups. Ask which study matches your plan; the results do not set an individual time limit.
There is no fixed three-year stop in this metastatic regimen; the team reviews response, side effects and the next treatment decision. Keep the separately agreed disease follow-up, endocrine and bone-health plan.
Explain the plan back: Which medicine is taken when, which test is due next, who reviews it, and which symptoms mean you should call today?
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