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Alectinib in a patient with ALK-positive non-small lung cancer unable to swallow capsules
Yoshihisa Ishiura1, Shosaku Nomura1, Yuka Ishii1
1First Department of Internal Medicine, Kansai Medical University, Osaka, Japan.
Introduction:
The treatment landscape of metastatic non-small-cell lung cancer (NSCLC) has changed dramatically in the last decade. Anaplastic lymphoma kinase (ALK) rearrangement has been a focus of interest since ALK inhibitors produced outstanding clinical results compared with chemotherapy with cytotoxic agents in patients with ALK-positive NSCLC.
Case Report:
We present the case of a 56-year-old woman with metastatic ALK-positive NSCLC and an inability to swallow capsules or tablets. Unfortunately, all ALK inhibitors are capsule or tablet formulations.
Management And Outcome:
We, therefore, decided to administer alectinib orally by opening the capsules and suspending the contents in water. Clinical imaging performed 12 months after initiating alectinib therapy indicated a complete response (CR). After 54 months of follow-up, CR has been maintained, and oral alectinib therapy has continued with no recurrence of the swallowing disturbance.
Discussion:
There are no current guidelines for oral targeted therapy in patients with swallowing disturbance, but alectinib administered orally by opening the capsules and suspending the contents in water can be a treatment option in patients with ALK-positive NSCLC and swallowing difficulty.
Insights
A patient with metastatic non-small-cell lung cancer (NSCLC) and swallowing difficulty achieved a complete response using alectinib administered orally. This method offers a viable treatment option for ALK-positive NSCLC patients unable to swallow capsules.
Area of Science:
- Oncology
- Pharmacology
Background:
- Metastatic non-small-cell lung cancer (NSCLC) treatment has evolved, with anaplastic lymphoma kinase (ALK) inhibitors showing significant efficacy.
- ALK-positive NSCLC patients benefit from targeted therapies, but formulation challenges exist.
Observation:
- A 56-year-old woman with metastatic ALK-positive NSCLC presented with dysphagia (difficulty swallowing) and could not take oral capsules or tablets.
- Standard ALK inhibitors are available only in capsule or tablet forms, posing a treatment barrier.
Findings:
- Alectinib was administered orally by opening capsules and suspending the contents in water.
- Complete response (CR) was achieved within 12 months and maintained for 54 months.
- The patient tolerated oral alectinib without recurrence of swallowing issues.
Implications:
- This case demonstrates a practical approach to administering oral targeted therapy in NSCLC patients with swallowing difficulties.
- Opening alectinib capsules and suspending contents in water can be a safe and effective alternative for ALK-positive NSCLC patients with dysphagia.
- Further research into guidelines for modified oral drug administration in oncology is warranted.
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