Alecnib

Indications

Alectinib is a targeted cancer medicine used to treat adults with non-small cell lung cancer (NSCLC) that is ALK-positive, meaning the cancer cells carry a change in the ALK gene. It is used for advanced or metastatic disease, including when the cancer has spread to the brain, and in some cases after surgery to lower the chance of the cancer coming back. It is prescribed and monitored by a cancer specialist after a test confirms the ALK change.

How It Works

In ALK-positive lung cancer, an abnormal ALK protein constantly signals the cancer cells to grow and divide. Alectinib blocks this ALK protein (a tyrosine kinase), which stops the growth signals and causes the cancer cells to die. It also crosses into the brain well, so it can act on cancer that has spread there.

Dosage and Administration

Take exactly as prescribed by your specialist. It is usually taken by mouth twice a day with food. Swallow the capsules whole: do not open or dissolve them. If you miss a dose or vomit after taking it, take the next dose at the usual time; do not take a double dose. The specialist may lower the dose or pause treatment if side effects occur.

Interactions

• Strong CYP3A inducers such as Rifampicin, Carbamazepine, Phenytoin and St John's Wort may reduce its effect.
• Medicines that slow the heart rate, such as beta blockers, Verapamil, Diltiazem, Digoxin and Clonidine: higher risk of a slow pulse.
• Some medicines carried by P-gp or BCRP (such as Dabigatran or Methotrexate) may have raised levels.
• Tell your doctor about all medicines, supplements and herbal products.

Contraindications

• Allergy to Alectinib or any ingredient.

Side Effects

Common side effects include constipation, tiredness, swelling of the ankles, feet or face (oedema), muscle aches, weight gain, anaemia, nausea, rash, sensitivity to sunlight and taste changes. Blood tests may show raised liver enzymes, bilirubin or creatine kinase (a muscle enzyme). Serious but less common effects include liver injury, inflammation of the lungs (interstitial lung disease), a very slow heartbeat, severe muscle damage and kidney problems.

Get urgent medical help if you have new or worsening cough or shortness of breath, yellowing of the skin or eyes with dark urine, a very slow heartbeat, dizziness or fainting, severe or unexplained muscle pain or weakness, or much less urine than usual.

Pregnancy and Lactation

Alectinib may harm an unborn baby. Women who could become pregnant must use effective contraception during treatment and for at least 5 weeks after the last dose, and men with partners who could become pregnant should use contraception for 3 months after the last dose. Do not breastfeed during treatment and for 1 week after the last dose.

Precautions and Warnings

• Regular blood tests for liver function and creatine kinase, and heart rate checks, are needed.
• Avoid prolonged sun exposure and use high-SPF sunscreen during treatment and for 7 days after stopping.
• Report any breathing problems promptly.
• The capsules contain lactose and sodium: tell your doctor if you have lactose intolerance or are on a salt-restricted diet.

Overdose

There is no specific antidote. If too much has been taken, contact your doctor or go to hospital straight away for monitoring and supportive care.

Therapeutic Class

Antineoplastic agent: anaplastic lymphoma kinase (ALK) inhibitor.

Storage

Store below 30°C in the original pack to protect from moisture and light, out of the reach of children. Return unused medicine to a pharmacy for safe disposal.