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Zhou Y, Yin Y, Xu J, Xu Z, Yang B, He Q, Luo P, Yan H, Yang X. An update on Alectinib: a first line treatment for ALK-positive advanced lung cancer. Expert Opin Pharmacother 2023; 24:1361-1373. [PMID: 37278051 DOI: 10.1080/14656566.2023.2221786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 06/01/2023] [Indexed: 06/07/2023]
Abstract
INTRODUCTION Alectinib is a second-generation, anaplastic lymphoma kinase (ALK) tyrosine kinase inhibitor (TKI) for the treatment of ALK+ non-small cell lung cancer (NSCLC) and is able to induce significant and durable CNS responses. However, long-term use of alectinib has been clinically reported to cause some serious and even life-threatening adverse events. There are currently no effective interventions for its adverse events, and this undoubtedly leads to delays in patient treatment and limits its long-term clinical use. AREAS COVERED Based on the clinical trials conducted so far, we summarize the efficacy and adverse events that occurred, especially those related to cardiovascular disorders, gastrointestinal disorders, hepatobiliary disorders, musculoskeletal and connective tissue disorders, skin and subcutaneous tissue disorders, and respiratory disorders. The factors that may influence alectinib selection are also described. Findings are based on a PubMed literature search of clinical and basic science research papers spanning 1998-2023. EXPERT OPINION The significant prolongation of patient survival compared with first-generation ALK inhibitor suggests its potential as a first-line treatment for the NSCLC, but the severe adverse events of alectinib limit its long-term clinical use. Future research should focus on the exact mechanisms of these toxicities, how to alleviate the adverse events caused by alectinib clinically, and the development of next-generation drugs with reduced toxicities.
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Affiliation(s)
- Yourong Zhou
- College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, China
| | - Yiming Yin
- College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, China
| | - Jiangxin Xu
- College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, China
- Department of Pharmacy, Hangzhou Red Cross Hospital (Hangzhou Chest Hospital Affiliated to Zhejiang University Medical College), Hangzhou, China
| | - Zhifei Xu
- College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, China
| | - Bo Yang
- Institute of Pharmacology & Toxicology, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, China
| | - Qiaojun He
- College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, China
- Innovation Institute for Artificial Intelligence in Medicine, Zhejiang University, Hangzhou, China
| | - Peihua Luo
- College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, China
- Department of Pharmacology and Toxicology, Hangzhou Institute of Innovative Medicine, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, China
| | - Hao Yan
- College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, China
| | - Xiaochun Yang
- College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, China
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王 可, 李 娟, 孙 建, 李 力, 张 西, 张 建, 余 敏, 叶 贤, 张 明, 张 瑜, 姚 文, 黄 媚. [Recommendations from Experts in the Management of Adverse Reactions
to ALK Inhibitors (2021 Version)]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2021; 24:815-828. [PMID: 34670356 PMCID: PMC8695243 DOI: 10.3779/j.issn.1009-3419.2021.102.32] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Anaplastic lymphoma kinase (ALK) fusion gene, as a tumor driver gene, was crucial for the occurrence and development of non-small cell lung cancer (NSCLC). Recently, targeted ALK fusion gene has become the main treatment method for ALK-positive NSCLC. The first and second generation ALK inhibitors (ALKi), such as crizotinib, ceritinib, alectinib and ensartinib have been approved in China. However, there was no guidance for the management of ALKi adverse reactions. Therefore, this "Recommendations from experts in the management of adverse reactions to ALK inhibitors (2021 version)" has been summarized, led by Lung Cancer Professional Committee of Sichuan Cancer Society and Sichuan Medical Quality Control Center for Tumor Diseases, to provide practical and feasible strategies for clinical ALKi management specification of adverse reactions.
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Affiliation(s)
- 可 王
- 610041 成都,四川大学华西医院呼吸与危重症医学科Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University, Chengdu 610041, China
| | - 娟 李
- 610041 成都,四川省肿瘤医院肿瘤内科Department of Oncology, Sichuan Cancer Hospital, Chengdu 610041, China
| | - 建国 孙
- 400037 重庆,陆军军医大学新桥医院肿瘤科Department of Oncology, Xinqiao Hospital, Army Military Medical University, Chongqing 400037, China
| | - 力 李
- 400042 重庆,陆军特色医学中心(大坪医院)呼吸与危重症医学科Department of Respiratory and Critical Care Medicine, Army Special Medical Center (Daping Hospital), Chongqing 400042, China
| | - 西 张
- 610000 成都,成都市第三人民医院肿瘤科Department of Oncology, Chengdu Third People's Hospital, Chengdu 610000, China
| | - 建勇 张
- 563000 遵义,呼吸与危重症医学科,遵义医科大学附属医院Department of Respiratory and Critical Care Medicine, Affiliated Hospital of Zunyi Medical University, Zunyi 563000, China
| | - 敏 余
- 610041 成都,四川大学华西医院胸部肿瘤科Department of Thoracic Oncology, West China Hospital of Sichuan University, Chengdu 610041, China
| | - 贤伟 叶
- 550002 贵阳,贵州省人民医院呼吸与危重症医学科Department of Respiratory and Critical Care Medicine, Guizhou Provincial People's Hospital, Guiyang 550002, China
| | - 明 张
- 650118 昆明,云南省肿瘤医院放射治疗科Department of Radiation Therapy, Yunnan Cancer Hospital, Kunming 650118, China
| | - 瑜 张
- 550002 贵阳,贵州省人民医院肿瘤科Department of Oncology, Guizhou Provincial People's Hospital, Guiyang 550002, China
| | - 文秀 姚
- 610041 成都,四川省肿瘤医院肿瘤内科Department of Oncology, Sichuan Cancer Hospital, Chengdu 610041, China
| | - 媚娟 黄
- 610041 成都,四川大学华西医院胸部肿瘤科Department of Thoracic Oncology, West China Hospital of Sichuan University, Chengdu 610041, China
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Pan Y, Xiao W, Ye F, Wang H, Shen Y, Yu X, Han X, Chu Q, Zhou C, Zhang Z, Ren S. Outcomes of switching from crizotinib to alectinib in patients with advanced non-small cell lung cancer with anaplastic lymphoma kinase fusion. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:1014. [PMID: 34277814 PMCID: PMC8267309 DOI: 10.21037/atm-21-2769] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 06/16/2021] [Indexed: 01/15/2023]
Abstract
BACKGROUND Alectinib and crizotinib have been approved as first-line therapies for advanced non-small cell lung cancer (NSCLC) with anaplastic lymphoma kinase (ALK) gene fusion. However, the therapeutic efficacy and side effects are still largely unknown of patients who switched to next-generation ALK tyrosine kinase inhibitors (ALK-TKIs), such as alectinib, after experiencing no disease progression with initial crizotinib treatment. METHODS This prospective real-world study enrolled patients who were treated with alectinib after experiencing no disease progression with initial crizotinib treatment. The patients' baseline characteristics, objective response rate (ORR) of crizotinib and alectinib, size change of target tumor lesions, treatment regimen and adverse events (AEs) were collected and analyzed. RESULTS The study included 53 patients, the majority of whom (96.2%) had non-squamous NSCLC. The median age was 51 (range, 31-80) years old. The ORR of first-line crizotinib was 54.7%. The ORR of sequential alectinib was 73.6%, and 90.5% of patients showed further tumor shrinkage after the alectinib treatment. The median progression-free survival was not reached, and 90.5% of patients were still enrolled in the study at the last follow-up. Among them, 34.0% of patients switched to alectinib treatment due to the toxicity. Crizotinib was associated with a higher frequency of AEs of grades 3 and 4 than alectinib (15.1% vs. 0%). Neither group had any AEs resulting in death. CONCLUSIONS Switching to alectinib might be an option for patients who do not experience disease progression with initial crizotinib therapy, and may promote better treatment compliance.
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Affiliation(s)
- Yingying Pan
- Department of Medical Oncology, Shanghai Pulmonary Hospital &Thoracic Cancer Institute, Tongji University School of Medicine, Shanghai, China
| | - Wenjing Xiao
- Department of Tumor Radiotherapy, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Feng Ye
- Xiamen Key Laboratory of Antitumor Drug Transformation Research, The First Affiliated Hospital of Xiamen University, Xiamen, China
| | - Huijuan Wang
- Department of Medical Oncology, The Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China
| | - Yihong Shen
- Department of Respiratory Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xinmin Yu
- Department of Thoracic Oncology, Zhejiang Cancer Hospital, Hangzhou, China
| | - Xiao Han
- Department of Internal Medicine-Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Qian Chu
- Department of Oncology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Caicun Zhou
- Department of Medical Oncology, Shanghai Pulmonary Hospital &Thoracic Cancer Institute, Tongji University School of Medicine, Shanghai, China
| | - Zhihong Zhang
- Department of Respiratory Oncology, Anhui Provincial Cancer Hospital (The First Affiliated Hospital of USTC West District), Hefei, China
| | - Shengxiang Ren
- Department of Medical Oncology, Shanghai Pulmonary Hospital &Thoracic Cancer Institute, Tongji University School of Medicine, Shanghai, China
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Hofman J, Sorf A, Vagiannis D, Sucha S, Novotna E, Kammerer S, Küpper JH, Ceckova M, Staud F. Interactions of Alectinib with Human ATP-Binding Cassette Drug Efflux Transporters and Cytochrome P450 Biotransformation Enzymes: Effect on Pharmacokinetic Multidrug Resistance. Drug Metab Dispos 2019; 47:699-709. [PMID: 31068367 DOI: 10.1124/dmd.119.086975] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 04/30/2019] [Indexed: 02/06/2023] Open
Abstract
Alectinib is a tyrosine kinase inhibitor currently used as a first-line treatment of anaplastic lymphoma kinase-positive metastatic nonsmall cell lung cancer (NSCLC). In the present work, we investigated possible interactions of this novel drug with ATP-binding cassette (ABC) drug efflux transporters and cytochrome P450 (P450) biotransformation enzymes that play significant roles in the phenomenon of multidrug resistance (MDR) of cancer cells as well as in pharmacokinetic drug-drug interactions. Using accumulation studies in Madin-Darby canine kidney subtype 2 (MDCKII) cells alectinib was identified as an inhibitor of ABCB1 and ABCG2 but not of ABCC1. In subsequent drug combination studies, we demonstrated the ability for alectinib to effectively overcome MDR in ABCB1- and ABCG2-overexpressing MDCKII and A431 cells. To describe the pharmacokinetic interaction profile of alectinib in a complete fashion, its possible inhibitory properties toward clinically relevant P450 enzymes (i.e., CYP1A2, CYP2B6, CYP2C8, CYP2C9, CYP2C19, CYP2D6, CYP3A4, or CYP3A5) were evaluated using human P450-expressing insect microsomes, revealing alectinib as a poor interactor. Advantageously for its use in pharmacotherapy, alectinib further exhibited negligible potential to cause any changes in expression of ABCB1, ABCG2, ABCC1, CYP1A2, CYP3A4, and CYP2B6 in intestine, liver, and NSCLC models. Our in vitro observations might serve as a valuable foundation for future in vivo studies that could support the rationale for our conclusions and possibly enable providing more efficient and safer therapy to many oncological patients.
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Affiliation(s)
- Jakub Hofman
- Departments of Pharmacology and Toxicology (J.H., A.S., D.V., S.S., M.C., F.S.) and Biochemical Sciences (E.N.), Faculty of Pharmacy in Hradec Kralove, Charles University, Hradec Kralove, Czech Republic; and Institute of Biotechnology, Brandenburg University of Technology Cottbus-Senftenberg, Senftenberg, Germany (S.K., J.-H.K.)
| | - Ales Sorf
- Departments of Pharmacology and Toxicology (J.H., A.S., D.V., S.S., M.C., F.S.) and Biochemical Sciences (E.N.), Faculty of Pharmacy in Hradec Kralove, Charles University, Hradec Kralove, Czech Republic; and Institute of Biotechnology, Brandenburg University of Technology Cottbus-Senftenberg, Senftenberg, Germany (S.K., J.-H.K.)
| | - Dimitrios Vagiannis
- Departments of Pharmacology and Toxicology (J.H., A.S., D.V., S.S., M.C., F.S.) and Biochemical Sciences (E.N.), Faculty of Pharmacy in Hradec Kralove, Charles University, Hradec Kralove, Czech Republic; and Institute of Biotechnology, Brandenburg University of Technology Cottbus-Senftenberg, Senftenberg, Germany (S.K., J.-H.K.)
| | - Simona Sucha
- Departments of Pharmacology and Toxicology (J.H., A.S., D.V., S.S., M.C., F.S.) and Biochemical Sciences (E.N.), Faculty of Pharmacy in Hradec Kralove, Charles University, Hradec Kralove, Czech Republic; and Institute of Biotechnology, Brandenburg University of Technology Cottbus-Senftenberg, Senftenberg, Germany (S.K., J.-H.K.)
| | - Eva Novotna
- Departments of Pharmacology and Toxicology (J.H., A.S., D.V., S.S., M.C., F.S.) and Biochemical Sciences (E.N.), Faculty of Pharmacy in Hradec Kralove, Charles University, Hradec Kralove, Czech Republic; and Institute of Biotechnology, Brandenburg University of Technology Cottbus-Senftenberg, Senftenberg, Germany (S.K., J.-H.K.)
| | - Sarah Kammerer
- Departments of Pharmacology and Toxicology (J.H., A.S., D.V., S.S., M.C., F.S.) and Biochemical Sciences (E.N.), Faculty of Pharmacy in Hradec Kralove, Charles University, Hradec Kralove, Czech Republic; and Institute of Biotechnology, Brandenburg University of Technology Cottbus-Senftenberg, Senftenberg, Germany (S.K., J.-H.K.)
| | - Jan-Heiner Küpper
- Departments of Pharmacology and Toxicology (J.H., A.S., D.V., S.S., M.C., F.S.) and Biochemical Sciences (E.N.), Faculty of Pharmacy in Hradec Kralove, Charles University, Hradec Kralove, Czech Republic; and Institute of Biotechnology, Brandenburg University of Technology Cottbus-Senftenberg, Senftenberg, Germany (S.K., J.-H.K.)
| | - Martina Ceckova
- Departments of Pharmacology and Toxicology (J.H., A.S., D.V., S.S., M.C., F.S.) and Biochemical Sciences (E.N.), Faculty of Pharmacy in Hradec Kralove, Charles University, Hradec Kralove, Czech Republic; and Institute of Biotechnology, Brandenburg University of Technology Cottbus-Senftenberg, Senftenberg, Germany (S.K., J.-H.K.)
| | - Frantisek Staud
- Departments of Pharmacology and Toxicology (J.H., A.S., D.V., S.S., M.C., F.S.) and Biochemical Sciences (E.N.), Faculty of Pharmacy in Hradec Kralove, Charles University, Hradec Kralove, Czech Republic; and Institute of Biotechnology, Brandenburg University of Technology Cottbus-Senftenberg, Senftenberg, Germany (S.K., J.-H.K.)
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Balzer BWR, Loo C, Wegner EA, Nath CE, Lee S, Smith C, Lewis CR, Trahair TN, Anazodo AC. Alectinib is effective, safe and tolerable in an adolescent with stage IVB ALK-rearranged adenocarcinoma of the lung. Pediatr Hematol Oncol 2018; 35:415-421. [PMID: 30526220 DOI: 10.1080/08880018.2018.1541492] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Anaplastic lymphoma kinase (ALK) inhibitors such as crizotinib and alectinib have been shown to have significant activity in ALK-rearranged non-small cell lung cancers (NSCLC). There are no data for alectinib's safety or efficacy in younger patients, though it is superior to crizotinib in adult trials. We present a 14-year old girl diagnosed with stage IV-B ALK-positive adenocarcinoma of the lung after presenting with cough and fever. She was commenced on alectinib at adult dose and has had sustained complete metabolic remission for 9 months. She is the youngest patient with lung adenocarcinoma to be treated with alectinib.
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Affiliation(s)
- Ben W R Balzer
- a Sydney Children's Hospital , Randwick , New South Wales , Australia.,b School of Women's and Children's Health , University of New South Wales , Randwick , New South Wales , Australia
| | - Christine Loo
- c Department of Anatomical Pathology , NSW Health Pathology, Prince of Wales Hospital , Randwick , New South Wales , Australia
| | - Eva A Wegner
- d Department of Nuclear Medicine and PET , Prince of Wales Hospital , Randwick , New South Wales , Australia.,e Prince of Wales Clinical School , University of New South Wales , Randwick , New South Wales , Australia
| | - Christa E Nath
- f Department of Biochemistry , The Children's Hospital at Westmead , Westmead , New South Wales , Australia.,g Faculty of Pharmacy , University of Sydney , Camperdown , New South Wales , Australia
| | - Samiuela Lee
- f Department of Biochemistry , The Children's Hospital at Westmead , Westmead , New South Wales , Australia
| | - Chantelle Smith
- h Pharmacy Department , Sydney Children's Hospital , Randwick , New South Wales , Australia
| | - Craig R Lewis
- e Prince of Wales Clinical School , University of New South Wales , Randwick , New South Wales , Australia.,i Department of Medical Oncology , Prince of Wales Hospital , Randwick , New South Wales , Australia
| | - Toby N Trahair
- a Sydney Children's Hospital , Randwick , New South Wales , Australia.,b School of Women's and Children's Health , University of New South Wales , Randwick , New South Wales , Australia.,j Sydney Children's Hospital , Kids Cancer Centre , Randwick , New South Wales , Australia
| | - Antoinette C Anazodo
- a Sydney Children's Hospital , Randwick , New South Wales , Australia.,b School of Women's and Children's Health , University of New South Wales , Randwick , New South Wales , Australia.,j Sydney Children's Hospital , Kids Cancer Centre , Randwick , New South Wales , Australia.,k Prince of Wales Hospital , Nelune Comprehensive Cancer Centre , Randwick , New South Wales , Australia
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Vavalà T, Novello S. Alectinib in the treatment of ALK-positive non-small cell lung cancer: an update on its properties, efficacy, safety and place in therapy. Ther Adv Med Oncol 2018; 10:1758835918789364. [PMID: 30090122 PMCID: PMC6077883 DOI: 10.1177/1758835918789364] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Accepted: 06/19/2018] [Indexed: 01/01/2023] Open
Abstract
Anaplastic lymphoma kinase (ALK) rearrangement is identified in 3–7% of advanced non-small cell lung cancer (NSCLC) cases, and ALK tyrosine kinase inhibitors (TKIs) have revolutionized the management of this subset of NSCLC patients. ALK–TKIs have been proven highly effective in ALK-rearranged advanced NSCLC patients, but after initial responses and benefit, a subsequent progression inevitably occurs. Understanding acquired-resistance mechanisms and defining an appropriate algorithm is becoming even more essential, particularly considering the availability of extremely efficacious next-generation ALK inhibitors. The aim of this review is the analysis of current data about ALK inhibition as a therapeutic strategy in ALK-rearranged NSCLC management, with a focus on a specific ALK–TKI, alectinib. Alectinib is a highly selective inhibitor of ALK and showed systemic and central nervous system (CNS) efficacy in the treatment of this particular population. The change of first-line approach, and consequently of further lines of therapy, in ALK-rearranged NSCLC patients is still a matter of debate. A summary of evidence from randomized trials evaluating alectinib will be presented in order to discuss the available clinical evidence, safety and place in therapy.
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Affiliation(s)
- Tiziana Vavalà
- SC of Oncology at ASL CN1, Ospedale Civile di Saluzzo, Cuneo, Italy
| | - Silvia Novello
- Department of Oncology, University of Torino, AOU S. Luigi Gonzaga, Regione Gonzole 10, Orbassano (TO), Turin, Orbassano 10043, Italy
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