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Alectinib

(al EK ti nib)

Trade Name: Alecensa®

Alectinib is the generic name for the trade name drug Alecensa®. In some cases, health care professionals may use the trade name Alecensa® when referring to the generic drug name alectinib.

Drug Type: Alectinib is an anti-cancer ("antineoplastic") targeted therapy. It is classified as a tyrosine kinase inhibitor ALK (anaplastic lymphoma kinase) gene mutation. (For more detail, see "How Alectinib Works" below).

What Alectinib Is Used For

  • For the treatment of metastatic non-small cell lung cancer (NSCLC) that is caused by a defect in a gene called ALK (anaplastic lymphoma kinase) who have progress or are intolerant to crizotinib. The cancer must be ALK-positive as indicated by an FDA-approved test.

Note: If a drug has been approved for one use, physicians may elect to use this same drug for other problems if they believe it may be helpful.

How Alectinib Is Given

  • Alectinib is a capsule, taken by mouth daily.
  • Consider taking at bedtime to decrease the risk for nausea or vomiting.
  • Take this medication with food.
  • Swallow alectinib capsules whole. Do not open, crush or dissolve the capsules.
  • Do not change your dose or stop alectinib unless your health care provider tells you to.
  • If you miss a dose, take your next dose at your usually scheduled time. Do not take an extra dose to make up for a missed dose.
  • If you take too much alectinib, call your health care provider right away and go to the emergency room.
  • Do not repeat a vomited dose.
  • Let your doctor know if you are starting any new medications as some medications interact with alectinib.

The amount of alectinib that you will receive depends on many factors, your general health or other health problems, and the type of side effects that you may have. Your doctor will determine your exact dosage and schedule.

Side Effects

Important things to remember about the side effects of alectinib:

  • Most people will not experience all of the alectinib side effects listed.
  • Side effects are often predictable in terms of their onset, duration, and severity.
  • There are many options to help minimize or prevent side effects.
  • There is no relationship between the presence or severity of side effects and the effectiveness of the medication.

The following side effects are common (occurring in greater than 30%) for patients taking alectinib:

These are less common side effects (occurring in 10-29%) for patients receiving alectinib:

Not all side effects are listed above. Side effects that are very rare -- occurring in less than about 10 percent of patients -- are not listed here. Always inform your health care provider if you experience any unusual symptoms.

What to Contact Your Doctor or Health Care Provider

Contact your health care provider immediately, day or night, and go to the emergency room, if you should experience any of the following symptoms:

  • Fever of 100.4º F (38º C) or higher, chills (possible signs of infection)
  • Signs of an allergic reaction, like rash, hives, itching, red, swollen, blistered or peeling skin with or without fever, wheezing, tightness in the chest or throat, trouble breathing or talking, shortness of breath, a cough that is new or worse, unusual hoarseness, or swelling of the mouth, face, lips, tongue, or throat.

The following symptoms require medical attention, but are not an emergency. Contact your health care provider within 24 hours of noticing any of the following:

  • Nausea (interferes with ability to eat and unrelieved with prescribed medication)
  • Vomiting (vomiting more than 4-5 times in a 24 hour period)
  • Diarrhea (4-6 episodes in a 24-hour period).
  • Unable to eat or drink for 24 hours or have signs of dehydration: tiredness, thirst, dry mouth, dark and decrease amount of urine, or dizziness.
  • Skin or the whites of your eyes turn yellow.
  • Urine turns dark or brown (tea color)
  • Pain on the right side of your stomach
  • Bleed or bruise more easily than normal
  • Itching
  • Cough with or without mucus
  • Extreme fatigue (unable to carry on self-care activities)
  • Unexplained muscle pain, tenderness or weakness
  • Dizziness, lightheadedness, or fainting.

Always inform your health care provider if you experience any unusual symptoms.

Precautions

  • Before starting alectinib treatment, make sure you tell your doctor about any other medications you are taking (including prescription, over-the-counter, vitamins, herbal remedies, etc.).
  • Do not receive any kind of immunization or vaccination without your doctor's approval while taking alectinib.
  • Inform your health care professional if you are pregnant or may be pregnant prior to starting this treatment. Pregnancy category D (alectinib may be hazardous to the fetus. Women who are pregnant or become pregnant must be advised of the potential hazard to the fetus).
  • For both men and women: Use contraceptives, and do not conceive a child (get pregnant) while taking alectinib. Barrier methods of contraception, such as condoms, are recommended for up to 6 months after last dose of alectinib.
  • Do not breast feed while taking alectinib.

Self-Care Tips

  • Drink at least two to three quarts of fluid every 24 hours, unless you are instructed otherwise.
  • You may be at risk of infection so try to avoid crowds or people with colds, and report fever or any other signs of infection immediately to your health care provider.
  • Wash your hands often.
  • To reduce nausea, take anti-nausea medications as prescribed by your doctor, and eat small, frequent meals. Try taking alectinib at bedtime.
  • Avoid sun exposure. Wear SPF 30 (or higher) sunblock and protective clothing.
  • In general, drinking alcoholic beverages should be kept to a minimum or avoided completely. You should discuss this with your doctor.
  • Get plenty of rest.
  • Maintain good nutrition.
  • Remain active as you are able. Gentle exercise is encouraged such as a daily walk.
  • If you experience symptoms or side effects, be sure to discuss them with your health care team. They can prescribe medications and/or offer other suggestions that are effective in managing such problems.

Monitoring and Testing While Taking Alectinib

You will be checked regularly by your doctor while you are taking alectinib to monitor side effects and check your response to therapy. Periodic blood work will be obtained to monitor your complete blood count (CBC), as well as organ function.

How Alectinib Works

Targeted therapy is the result of about 100 years of research dedicated to understanding the differences between cancer cells and normal cells. To date, cancer treatment has focused primarily on killing rapidly dividing cells because one feature of cancer cells is that they divide rapidly. Unfortunately, some of our normal cells divide rapidly too, causing multiple side effects.

Targeted therapy is about identifying other features of cancer cells. Scientists look for specific differences in the cancer cells and the normal cells. This information is used to create a targeted therapy to attack the cancer cells without damaging the normal cells, thus leading to fewer side effects. Each type of targeted therapy works a little bit differently but all interfere with the ability of the cancer cell to grow, divide, repair and/or communicate with other cells.

There are different types of targeted therapies, defined in three broad categories. Some targeted therapies focus on the internal components and function of the cancer cell. The targeted therapies use small molecules that can get into the cell and disrupt the function of the cells, causing them to die. There are several types of targeted therapy that focus on the inner parts of the cells. Other targeted therapies target receptors that are on the outside of the cell. Therapies that target receptors are also known as monoclonal antibodies. Antiangiogenesis inhibitors target the blood vessels that supply oxygen to the cells, ultimately causing the cells to starve.

Alectinib is a targeted therapy. It is a tyrosine kinase inhibitor (TKI). Tyrosine kinases are specific enzymes (a type of protein) that may signal cancer cells to grow. TKI's block these cell signals and by blocking the signals, they stop the growth of the cancer cells. TKI's are named based on the enzyme that they block. Alectinib blocks the abnormal ALK (anaplastic lymphoma kinase) protein.

Note: We strongly encourage you to talk with your health care professional about your specific medical condition and treatments. The information contained in this website is meant to be helpful and educational, but is not a substitute for medical advice.

Reference:

  • Alectinib. Lexicomp Online® [updated 2017 May 15; cited 2017 May 22]. Lexi-Drugs®. Hudson, Ohio: Lexi-Comp, Inc.; May 22, 2017.
  • Alecensa® (Alectinib) [package insert]. Genentech USA, Inc. South San Francisco, CA, a member of the Roche Group.; 2015.

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