Alectinib

Alectinib is a tyrosine kinase inhibitor and is generally used to treat non-small-cell lung cancer which has spread to other parts of the body.

Overview

Although Alectinib is used to treat non-small-cell lung cancer (NSCLC), it is not normally used on every patient with this type of condition. In fact, Alectinib is limited to use in patients who have anaplastic lymphoma kinase (ALK)-positive metastatic non-small-cell lung cancer.

Most often, Alectinib is used when patients are unable to take alternative medication, such as Crizotinib (Xalkori), or when alternative medication has failed to achieve the desired results.

As a tyrosine kinase inhibitor, Alectinib works by affecting the production of cells. In instances of ALK-positive metastatic non-small-cell lung cancer, an abnormal protein sends signals to the cancer cells which prompts them to multiply, thus causing the cancer to spread further.

When Alectinib is taken, it blocks the signal from the abnormal protein and the cell does not, therefore, multiply. As a result, the spread of cancer is stopped or slowed considerably.

Although Alectinib is currently used to treat ALK-positive metastatic NSCLC, it is being used in a number of clinical trials. If successful, Alectinib could also be used to treat advanced solid tumors, RET-Rearranged Stage IIIB-IV NSCLC and/or RET-Mutated Stage IV thyroid cancer.

Conditions Treated:

  • ALK-positive metastatic non-small-cell lung cancer

Type of Medicine:

  • Antineoplastic; Tyrosine Kinase Inhibitor

Side Effects:

Similar to most antineoplastic, or anti-cancer, drugs, Alectinib can cause some patients to suffer side-effects. Whilst mild side-effects can often be tolerated well, doctors may provide additional medications to treat more moderate or serious side effects.

According to patient reports, side-effects commonly associated with Alectinib include:

  • Lightheadedness
  • Fainting
  • Dizziness
  • Diarrhea
  • Constipation
  • Rash
  • Weight
  • Headaches
  • Swelling of the hands, feet, eyelids or ankles
  • Difficulty moving
  • Tingling in the extremities
  • Chest pain
  • Cough
  • Joint pain
  • Back pain
  • Blurred vision
  • Skin Lesions
  • Muscles aches and/or stiffness
  • Shortness of breath
  • Slow or irregular heartbeat

Somewhat less common side-effects have also been reported by patients taking Alectinib. These may include:

  • Loss of appetite
  • Nausea
  • Vomiting
  • Fever
  • Yellowing of the eyes of the skin
  • Clay-colored stools
  • Dark urine

Patients should always report side-effects to their doctor so that appropriate monitoring can be put in place. In some cases, the presence of certain side-effects may indicate that the medication be discontinued. By discussing their side-effects with their physician, patients can ensure that the medication is working correctly and that they are not at risk of suffering further complications.

Dosage:

Alectinib is normally given in capsule format but the patient’s dose will depend on various factors. As well as following the instructions stated on the medication packaging, patients should adhere to their doctor’s instructions when taking the medication.

Patients are normally advised to take Alectinib capsules or tablets with food but individual advice should be sought. Generally, food increases the absorption of Alectinib and the medication is, therefore, more effective if taken with a meal.

If the patient misses a dose of Alectinib, they should simply take their next dose at the appropriate time, rather than taking two doses at once. Similarly, if a patient vomits after taking a dose of Alectinib, they should not attempt to take this dose again and should merely take their next dose when scheduled to do so.

In most cases, adult patients will be advised to take 600 milligrams of Alectinib twice daily. Following this, a reduction schedule is normally implemented and patients will gradually reduce their dose to 450 milligrams daily to 300 milligrams daily, before discontinuing treatment. It must be noted, however, that this is an example of an average treatment plan. Each patient’s dosage is unique and will be determined by their own physician.

When patients experience additional conditions, their dose of Alectinib may need to be altered. If a patient experiences bradycardia, for example, treatment with Alectinib may be suspended until the patient is asymptomatic or discontinued if the symptoms of bradycardia continue to worsen.

Similarly, if patients show signs of hepatotoxicity, Alectinib may be discontinued until ALT and AST is no longer elevated.

In rare cases, patients may show signs of an allergic reaction when taking Alectinib. If patients exhibit symptoms, such as fever, difficulty in breathing, facial swelling or changes in their heart rate, they should seek immediate medical assistance.

Similarly, if a patient exceeds the stated dose of Alectinib, they should seek medical help. Patients can contact a local poison control center on 1-800-222-1222 in the event of a suspected overdose. A collapse following an overdose of Alectinib is a medical emergency and 911 should be called.

Interactions:

Medications can interact with each other and taking two or medications at the same time may affect the way they work. Due to this, some drugs should not be taken together or close monitoring should be arranged so that the patient is not at risk of declining.

When patients are receiving treatment, Alectinib may interact with the following medications:

  • Leflunomide
  • Teriflunomide
  • Lomitapide
  • Mipomersen

Other medications, vitamins, and supplements could also interact with Alectinib so it’s vital that patients seek advice from their doctor before taking any medication alongside Alectinib. Whilst some drugs may indicate a possible interaction, physicians will determine whether the risk of taking the two medications at the same time is outweighed by the benefits of the treatment regimen.

Warnings:

All medications carry some risks, but these can be reduced if the patient discloses their full medical history to their physician. If the patient regularly uses recreational or over-the-counter drugs, for example, they should notify their doctor so that treatment can be modified as appropriate.

Alectinib may have an adverse impact on existing medical conditions, including:

  • Bradycardia
  • Hepatic Impairment
  • Myalgia
  • Renal Impairment
  • Lung Toxicity

If a patient has been diagnosed with any of these conditions, either recently or in the past, they should inform their doctor before taking Alectinib. Whilst the medication can normally be taken by patients with these conditions, regular testing may be required in order to ensure that existing conditions aren’t worsened.

Patients with hepatic impairment should undergo liver tests fortnightly during the first two months of Alectinib treatment, for example. Depending on their liver function, their dose of Alectinib may be changed or treatment may be suspended. If liver function remains adequate during this time, blood tests can be performed on a regular but less frequent basis.

Although rare, Alectinib can worsen symptoms of interstitial lung disease. If patients with this condition experience an increase of symptoms when taking Alectinib, they medication may need to be discontinued and replaced with an alternative.

Asymptotic bradycardia does not normally warrant dosage reduction when patients are receiving Alectinib. If the patient shows signs of symptomatic bradycardia and/or their heart rate drops to less than 60 bpm, however, Alectinib should be temporarily discontinued. Once the patient’s heart rate has risen to at least 60 bpm, Alectinib can be administered again but should be stopped if it causes a second incidence of symptomatic bradycardia.

Some muscle pain or stiffness is relatively common when taking Alectinib and this does not necessarily mean that treatment should be stopped. Patients with myalgia, however, should have their creatine phosphokinase levels tested fortnightly for the first month of treatment with Alectinib. If levels of creatine phosphokinase are elevated, the dose of Alectinib may be reduced or the medication may be stopped altogether.

Patients with any of these pre-existing conditions are advised to seek immediate medical help if their symptoms worsen when taking Alectinib.

As Alectinib can cause fetal harm, it should not normally be prescribed to pregnant women. If no alternative is available, the potential dangers of taking Alectinib when pregnant should be discussed with the patient. If the patient becomes pregnant whilst taking Alectinib, they are advised to contact their physician immediately.

Due to the risk of fetal harm occurring, patients should be advised to use additional birth control methods whilst taking Alectinib and for at least one week after discontinuing treatment. In addition to this, nursing mothers should not be given Alectinib. In general, mothers should not breastfeed whilst taking this medication and should refrain from breastfeeding for at least one week after their last dose of Alectinib.

Due to the potential of fetal harm, male patients are also advised not to father a child whilst taking Alectinib. If their partner becomes pregnant whilst taking this medication, the patient should inform their physician straightaway and their partner should notify their own doctor immediately.

Patients may experience photosensitivity whilst taking Alectinib and this may continue for some time after treatment has been discontinued. Prolonged sun exposure should, therefore, be avoided and patients should make use of sunblock to prevent damage occurring. Broad spectrum UVA/UVB sunscreen and lip balm is often recommended for patients who are taking Alectinib or who have taken it within the last seven days.

Storage

As Alectinib is usually provided in capsule or tablet form, the medication can be stored by the patient at home. A suitable location should be found, however, and the medication should be kept away from children and pets so that it cannot be accidentally ingested. Using child-resistant locks to secure medicine cabinets and safety caps on medication can help to prevent it from being taken by anyone other than the intended patient.

In most cases, it is advisable to store the medication in its original packaging, in a dry environment. Alectinib should also be stored in a moisture-free environment, out of direct light, with temperatures not exceeding 30°C (86°F).

Once treatment has finished, patients may have remaining tablets or capsules which they need to dispose of. This should be done so carefully and in accordance with any local health and safety guidelines. If in doubt, patients should seek advice from their pharmacist when disposing of medications.

Summary

Alectinib is an effective form of treatment for patients who have been diagnosed with anaplastic lymphoma kinase (ALK)-positive metastatic non-small-cell lung cancer. Although it is not normally the first treatment to be administered, it is appropriate for patients who are unable to take more common medicines. Similarly, Alectinib can be effective in patients when other tyrosine kinase inhibitors have failed to work.

When non-small-cell lung cancer has become metastatic, it’s crucial to stop or slow the rate at which the cancer is spreading. By targeting the proteins which cause cell division, Alectinib can successfully prevent non-small-cell lung cancer (NSCLC) from spreading and the patient’s condition worsening.

Whilst some pre-existing conditions are contra-indicators to treatment with Alectinib, most patients with these conditions can commence treatment with careful monitoring. In many instances, Alectinib provides effective treatment for patients within this group and does not cause existing conditions to notably worsen.

With unique treatment plans and patient-led regimes, Alectinib is, therefore, an appropriate and effective way to treat lymphoma kinase (ALK)-positive metastatic non-small-cell lung cancer.

Resources
Last Reviewed:
December 10, 2017
Last Updated:
December 22, 2017