Do you feel comfortable using ribociclib in a patient with metastatic ER+/HER2+ breast cancer who has borderline systolic heart failure from previous HER2 based treatment?

My short answer to the question is, yes, I would feel comfortable treating a metastatic breast cancer with ribociclib despite the presence of borderline CHF related to prior anti-HER-2 therapy.

As always, in the treatment of metastatic breast cancer, decisions regarding treatment typically come down to an individualized choice regarding treatment, weighing potential risks, benefits, and alternatives.

There are several complex issues contained within this question.

Firstly, this patient presumably has metastatic ER+/HER-2+ breast cancer, or at least I would assume this is likely given the limited details offered. It is certainly possible the patient is ‘HER-2 low’ and received fam-trastuzumab-deruxtecan, but generally, ER+ patients would rec...