Working my through the CDK4/6 inhibitors.

Hi all, hope you’re having a good day. Hoping for some help deciphering this.

So I started on Kisqali early Jan. It worked wonders but I had to switch to Ibrance due to elevated liver enzymes. There was a short break in between the 2 drugs (a few weeks) but my ALT had not yet normalised.

My scans in April were really good and last month, a DWI-MRI and breast-specific MRI have confirmed I am NEAD except from some activity remaining in my breast. The plan is to do a DMX to address the breast issue and I have an appointment to speak to the surgeon about that this week, with a view to finding a date for the op.

However, I went for my next cycle bloods today and my ALT has risen to 245. AST is 127, ALP and Bilirubin are normal. I do a lot of running/ exercise in general so had kinda been hoping that might play a part but appreciate these numbers are high. I also feel totally normal but have basically had elevated ALT for 6 months now (this is the highest level it’s been).

I’m just not sure what to do:

1. Has anyone encountered liver issues with Ibrance?
2. Has anyone else been in the position where CDK4/6 inhibitors kick the crap out of their cancer but their liver can’t deal with the meds and if so, what did you do?
3. Has anyone’s ALT/AST recovered from this sort of level and they’ve been able to stay on the meds long term?

I am also a bit worried as so many combination trials involve CDK4/6 inhibitors that I’m not sure if I’ve much less in the way of options if my liver can’t handle them?

Thanks for reading and for any thoughts x