Ribociclib (Kisqali)

Ribociclib is a type of targeted cancer drug. You pronounce it as rye-boe-sye-clib. It is also known as Kisqali.

It is a treatment for breast cancer that has:

• spread to another part of the body (advanced or metastatic breast cancer)

• spread to the area and structures surrounding the breast, such as nearby lymph nodes, muscle and skin, but not to other parts of the body (locally advanced breast cancer)

You usually have this in combination with a hormone therapy drug.

Ribociclib is used for breast cancer that is hormone receptor positive (HR+)  and human epidermal growth factor receptor negative (HER2-). You have tests on a sample of breast cancer cells to check for this.

How does ribociclib work?

Ribociclib is a type of cancer growth blocker . It targets proteins called cyclin dependant kinase 4 and cyclin dependant 6 (CDK 4 and CDK 6) on breast cancer cells.

CDK 4 and CDK 6 are proteins that stimulate cancer cells to divide and grow.

Ribociclib works by blocking these proteins. It aims to slow or stop the growth of the cancer.

How do you take ribociclib?

You take ribociclib as tablets. You can take the tablets with or without food. You take them at the same time each day. Swallow the tablets whole. Do not crush, chew or break them.

Taking your tablets

You should take the right dose, not more or less.

Talk to your healthcare team before you stop taking a cancer drug, or if you miss a dose.

When you take ribociclib

You have ribociclib as cycles of treatment. This means that you have the drug and then a rest to allow your body to recover. One cycle lasts 28 days (4 weeks).

You have ribociclib in the following way:

You then start a new cycle of treatment.

Tests

You have blood tests before and during your treatment. They check your levels of blood cells and other substances in the blood. They also check how well your liver and kidneys are working.

You also have a test to check the health of your heart before and during your treatment. This is called an electrocardiogram or ECG.

Side effects

Side effects can vary from person to person. They also depend on what other treatments you're having. 

When to contact your team

Your doctor, nurse or pharmacist will go through the possible side effects. They will monitor you during treatment and check how you are at your appointments. Contact your advice line as soon as possible if:

• you have severe side effects 

• your side effects aren’t getting any better

• your side effects are getting worse

Early treatment can help manage side effects better. 

We haven't listed all the side effects here. Remember it is very unlikely that you will have all of these side effects. But you might have some of them at the same time.

Common side effects

These side effects happen in more than 10 in 100 people (more than 10%). You might have one or more of them. They include:

Increased risk of infection

Increased risk of getting an infection is due to a drop in white blood cells. Symptoms include a change in temperature, aching muscles, headaches, feeling cold and shivery and generally unwell. You might have other symptoms depending on where the infection is.

Infections can sometimes be life threatening. You should contact your advice line urgently if you think you have an infection. 

Breathlessness and looking pale due to a drop in red blood cells

You might be breathless and look pale due to a drop in red blood cells. This is called anaemia.

Loss of appetite

You might lose your appetite for various reasons while having cancer treatment. Sickness, taste changes or tiredness can put you off food and drinks.

Headaches and dizziness

Let your doctor or nurse know if you have headaches. They can give you painkillers. Don’t drive or operate machinery if you feel dizzy.

Difficulty breathing or cough

You may have difficulty breathing or a cough. Let your doctor or nurse know straight away if this happens. 

Less commonly, you could develop inflammation in your lungs (pneumonitis ).

Feeling or being sick

Feeling or being sick is usually well controlled with anti sickness medicines. It might help to avoid fatty or fried foods, eat small meals and snacks and take regular sips of water. Relaxation techniques might also help.

It is important to take anti sickness medicines as prescribed even if you don’t feel sick. It is easier to prevent sickness rather than treat it once it has started.

Diarrhoea or constipation

Tell your healthcare team if you have diarrhoea or constipation. They can give you medicine to help. 

Sore mouth

Mouth sores and ulcers can be painful. Less commonly, you might have a sore throat or your mouth might be dry.

Keep your mouth and teeth clean; drink plenty of fluids; avoid acidic foods such as oranges and lemons; chew gum to keep the mouth moist and tell your doctor or nurse if you have ulcers.

Tummy (abdominal) pain

Tell your treatment team if you have this. They can check the cause and give you medicine to help. 

Hair thinning and hair loss

You may have some hair loss or hair thinning. This can be upsetting. Your hair usually grows back once treatment has finished.

Skin problems

Skin problems include a rash and itchy skin. Less commonly your skin might get dry, redden or develop patchy loss of skin colour.

Some skin conditions usually go back to normal when your treatment finishes. Your healthcare team can tell you what products you can use on your skin to help.

Back pain

You might have back pain. Speak to your doctor if this is a problem for you. They can prescribe medicine to help. 

Tiredness and weakness

You might feel very tired and as though you lack energy.

Various things can help you to reduce tiredness and cope with it, for example exercise. Some research has shown that taking gentle exercise can give you more energy. It is important to balance exercise with resting.

Fluid build up in your hands, ankles or feet 

You may develop swollen hands, ankles or feet with this treatment. Speak to your doctor or nurse if you are worried. 

Liver changes

You might have liver changes that are usually mild and unlikely to cause symptoms. They usually go back to normal when treatment finishes. You have regular blood tests to check for any changes in the way your liver is working.

Less commonly the liver can get injured causing it to not work properly.

Indigestion or heartburn

Contact your doctor or pharmacist if you have indigestion or heartburn. They can prescribe medicines to help.

Occasional side effects

These side effects happen in between 1 and 10 out of every 100 people (between 1 and 10%). You might have one or more of them. They include:

• low levels of platelets – this can increase your risk of bleeding

• changes to the levels of salts and minerals in the blood – you have regular blood tests to check this

• the feeling of the room spinning or moving around you (vertigo)

• eye problems such as watery or dry eyes

• fainting or passing out

• taste changes

• kidney problems – your blood tests might show changes to how well your kidneys are working

• changes to the rhythm or activity of your heart – you have a heart trace (electrocardiogram, ECG) during treatment to check this

Coping with side effects

We have more information about side effects and tips on how to cope with them.

What else do I need to know?

Other medicines, foods and drinks

Cancer drugs can interact with medicines, herbal products, and some food and drinks. We are unable to list all the possible interactions that may happen. An example is grapefruit or grapefruit juice which can increase the side effects of certain drugs.

Tell your healthcare team about any medicines you are taking. This includes vitamins, herbal supplements and over the counter remedies. Also let them know about any other medical conditions or allergies you may have.

Peanut and soya allergy

Do not take ribociclib if you are allergic to peanuts or soya because it contains soya bean oil.

Loss of fertility

It is not known whether this treatment affects fertility in people. Talk to your doctor before starting treatment if you think you may want to have a baby in the future.

Contraception and pregnancy

It is unknown whether treatment may or may not harm a baby developing in the womb. It is important not to become pregnant or get someone pregnant while you are having treatment.

Women having ribociclib should use 2 forms of contraception during treatment and for at least 21 days (3 weeks) after treatment finishes.

Talk to your healthcare team about contraception you can use during treatment.

It is not known whether this drug comes through into the breast milk. Doctors usually advise that you don’t breastfeed during this treatment and for at least 21 days (3 weeks) after treatment finishes.

Breastfeeding

Treatment for other conditions

If you are having tests or treatment for anything else, always mention your cancer treatment. For example, if you are visiting your dentist.

Immunisations

Don’t have immunisations with live vaccines while you’re having treatment and for up to 12 months afterwards. The length of time depends on the treatment you are having. Ask your doctor or pharmacist how long you should avoid live vaccinations.

In the UK, live vaccines include rubella, mumps, measles, BCG, yellow fever and one of the shingles vaccines called Zostavax.

You can have:

• other vaccines, but they might not give you as much protection as usual
• the flu vaccine (as an injection)
• the coronavirus (COVID-19) vaccine - talk to your doctor or pharmacist about the best time to have it in relation to your cancer treatment

Members of your household who are aged 5 years or over are also able to have the COVID-19 vaccine. This is to help lower your risk of getting COVID-19 while having cancer treatment and until your immune system recovers from treatment.

Contact with others who have had immunisations - You can be in contact with other people who have had live vaccines as injections. Avoid close contact with people who have recently had live vaccines taken by mouth (oral vaccines) such as the oral typhoid vaccine. Sometimes people who have had the live shingles vaccine can get a shingles type rash. If this happens they should keep the area covered.

If your immune system is severely weakened, you should avoid contact with children who have had the flu vaccine as a nasal spray as this is a live vaccine. This is for 2 weeks following their vaccination.

Babies have the live rotavirus vaccine. The virus is in the baby’s poo for about 2 weeks and could make you ill if your immunity is low. Get someone else to change their nappies during this time if you can. If this isn't possible, wash your hands well after changing their nappy.

More information about this treatment

For further information about this treatment and possible side effects go to the electronic Medicines Compendium (eMC) website. You can find the patient information leaflet on this website.

You can report any side effect you have to the Medicines Health and Regulatory Authority (MHRA) as part of their Yellow Card Scheme.