- Monitor for diarrhea, may result in dehydration and infection. Grade 1: no dose modification required. Grade 2: If resolves in 24 hrs to
Grade 1, suspend therapy until resolution. No dose reduction required. Grade 2 that persists or recurs after resuming same dose despite maximum supportive measures: Hold dose until diarrhea resolves to Grade 1. Resume at next lower dose. Grade 3 or 4 diarrhea or diarrhea that requires hospitalization, withhold abemaciclib until resolves to Grade 1, then resume at next lower dose. - Monitor for signs and symptoms of venous thrombosis and pulmonary embolism and treat as needed.
- Verify negative pregnancy test before starting therapy.
- Monitor CBC before starting, every 2 wk for first 2 mo, monthly for next 2 mo, and as clinically indicated. Grade 1 or 2 neutropenia: No dose reduction required. Grade 3: Hold dose until resolves to Grade 2. Grade 3 recurrent or Grade 4: Hold therapy until resolved to Grade 2. Resume at next lower dose.
- Monitor ALT, AST, and serum bilirubin prior to starting therapy, every 2 wk for first 2 mo, monthly for next 2 mo, and as clinically indicated. If Grade 1 (>upper limit of normal [ULN] to 3 times ULN), Grade 2 (>3.0 to 5.0 times ULN, without ↑ in total bilirubin >2 times ULN): no dose reduction required. If persistent or recurrent Grade 2, or Grade 3 (>5.0–20.0 x ULN), without ↑ in total bilirubin above 2 x ULN: Hold therapy until toxicity resolves to baseline or Grade 1. Resume at next lower dose. If elevation in AST and/or ALT >3 x ULN with total bilirubin >2 x ULN, in the absence of cholestasis or Grade 4 (>20.0 x ULN): discontinue therapy.
- May cause ↑ serum creatinine without glomerular function being affected. Monitor BUN, cystatin C, or calculated glomerular filtration rate to determine impaired renal function.
- Monitor CBC before starting, every 2 wk for first 2 mo, monthly for next 2 mo, and as clinically indicated. Grade 1 or 2 neutropenia: No dose reduction required. Grade 3: Hold dose until resolves to