Interstitial lung disease induced by alectinib (CH5424802/RO5424802)

Area of Science:

• Oncology
• Pulmonology
• Pharmacology

Background:

• Anaplastic lymphoma kinase (ALK) rearrangement is a key driver in a subset of non-small cell lung cancer (NSCLC).
• Alectinib is a potent and selective ALK inhibitor used in treating ALK-rearranged NSCLC.
• Third-line treatment strategies are crucial for advanced-stage cancer patients.

Observation:

• A 75-year-old woman with Stage IV ALK-rearranged lung adenocarcinoma developed diffuse ground glass opacities on chest CT 102 days after starting alectinib.
• Elevated serum KL-6, SP-D, and lactate dehydrogenase levels were noted without clinical symptoms or signs of infection.
• Bronchoalveolar lavage revealed lymphocytosis, and lung biopsy showed interstitial changes consistent with inflammation.

Findings:

• The observed interstitial lung disease was attributed to alectinib treatment.
• Discontinuation of alectinib led to improvement in imaging findings and serum biomarkers.
• This represents the first documented case of alectinib-induced interstitial lung disease.

Implications:

• Alectinib, while effective for ALK-rearranged NSCLC, carries a risk of interstitial lung disease.
• Close monitoring for pulmonary toxicity is essential in patients receiving alectinib.
• Further clinical trials are needed to fully understand the long-term safety profile of alectinib.