Alectinib-Induced Severe Hemolytic Anemia in a Patient with ALK-Positive Non-Small Cell Lung Cancer: A Case Report

Abstract

Alectinib is a selective anaplastic lymphoma kinase (ALK) tyrosine kinase inhibitor as standard therapy for ALK-rearranged non-small cell lung cancer (NSCLC). Hemolytic anemia is considered as a rare but significant adverse event with alectinib. Here, we report a case of a 73-year-old female with lung adenocarcinoma, harbouring an ALK fusion gene, who received alectinib as second-line therapy and developed gradually progressive grade 4 (6.4 g/dL) drug-induced hemolytic anemia (DIHA) after complete response. We discontinued alectinib and performed a blood transfusion for the severe anemia. The anemia improved with no recurrence of lung adenocarcinoma over 10 months. Regular hematologic monitoring and the possibility of DIHA should be considered in case of progressive hemolytic anemia during alectinib treatment.

Keywords:

• non-small cell lung cancer
• ALK
• alectinib
• drug-induced hemolytic anemia

Summary

Drug-induced hemolytic anemia is a significant adverse event caused by alectinib treatment in a patient with ALK-positive non-small cell lung cancer.

Ethical Approval

Institutional approval was not required to publish the case details.

Consent for Publication

Informed consents were obtained from the patients for publication.

Disclosure

Dr. Kubota received research fund from Nihon Kayaku, AstraZeneca, Pfizer, and payment or honoraria for lectures and presentations from Chugai Pharmaceutical. Dr. Seike received payment or honoraria for lectures and presentations from AstraZeneca, Chugai Pharmaceutical, Taiho Pharmaceutical, MSD, Ono Pharmaceutical, Bristol–Myers Squibb, Eli Lilly Japan, Takeda Pharmaceutical, Nihon Kayaku, Nippon Boehringer Ingelheim, Pfizer, Kyowa–Hakko Kirin, and Novartis. The other authors report no conflicts of interest in this work.