CDK4/6 inhibitor-statin interaction and rhabdomyolysis in breast cancer treatment: a case-based systematic review
Abstract
Purpose: Cyclin-dependent kinase (CDK) 4/6 inhibitors have significantly advanced the treatment of hormone receptor-positive, HER2-negative metastatic breast cancer, improving outcomes. However, their concurrent use with statins, a widely prescribed class of drugs, may pose a risk of rhabdomyolysis due to pharmacokinetic and pharmacodynamic interactions. This systematic review analyzes reported cases to characterize clinical presentations, therapeutic approaches, and outcomes.
Methods: A systematic search of PubMed, Embase, Scopus, and Web of Science from inception to January 2026 for case reports and case series documenting rhabdomyolysis in patients treated with CDK4/6 inhibitors. Data on demographics, clinical features, laboratory findings, management strategies, and outcomes were extracted. Quality assessment of the included cases was performed using the Joanna Briggs Institute Critical Appraisal Checklist.
Results: Seven case reports involving female patients aged 55-81 years were analyzed. All patients were treated for metastatic breast cancer with CDK4/6 inhibitors (ribociclib, palbociclib, or abemaciclib) alongside statins (simvastatin, atorvastatin, or rosuvastatin). Rhabdomyolysis onset ranged from 3 days to 48 months after initiation of combination therapy, or shortly after statin dose escalation in the setting of long-term CDK4/6 inhibitor use. Clinical presentations included severe myalgia, muscle weakness, and dark urine, with creatine kinase levels ranging…
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