Alectinib is highly effective in treating ALK-positive lung cancer, but various side effects may occur during treatment.

Overview of Common Side Effects of Alectinib 

1. Hepatotoxicity:

Manifests as elevated transaminases and bilirubin, mostly occurring within the first 3 months of treatment.

2. Constipation:

Occurs in most patients and is the most common gastrointestinal adverse reaction.

3. Muscle pain:

Most patients experience myalgia, and about 56% have elevated creatine kinase levels.

4. Fatigue and edema:

Fatigue and swelling of the limbs and face are common.

5. Other common reactions:

Rash, cough, renal impairment, bradycardia.

Management of Hepatotoxicity

1. Regular monitoring:

(1) Monitor liver function every 2 weeks for the first 3 months of treatment, then monthly thereafter.

(2) Patients with elevated transaminases require more frequent monitoring.

2. Recognize warning signs:

Seek immediate medical attention if fatigue, loss of appetite, yellowing of skin or eyes, dark urine, right upper quadrant pain, or unusual bleeding or bruising occur.

3. Dose adjustment:

If ALT/AST exceed 5 times the upper limit of normal, temporarily interrupt treatment and resume at a reduced dose after recovery; if bilirubin simultaneously exceeds 2 times the upper limit, permanently discontinue.

Mitigation Measures for Muscle Issues

1. Monitor markers:

Check creatine kinase levels every 2 weeks during the first month of treatment.

2. Report promptly:

Inform your doctor immediately if you experience unexplained or persistent muscle pain, tenderness, or weakness.

3. Graded management:

Depending on the severity of creatine kinase elevation, the doctor will decide whether to interrupt treatment, resume, or reduce the dose.

Management of Cardiopulmonary Side Effects

1. Bradycardia:

(1) Heart rate below 60 beats per minute. Monitor heart rate and blood pressure regularly.

(2) Seek medical attention if symptoms such as dizziness, fatigue, or fainting occur.

(3) Asymptomatic patients do not require dose adjustment.

2. Pulmonary inflammation:

(1) Incidence of interstitial lung disease is 1.3%.

(2) If new or worsening difficulty breathing, shortness of breath, cough, or fever occur, seek immediate medical attention and permanently discontinue treatment.

Other Side Effects and Daily Care

1. Renal protection:

(1) Monitor changes in urine output, urine color, and swelling of legs and feet.

(2) For grade 3 renal impairment, interrupt treatment; permanently discontinue for grade 4.

2. Sun protection measures:

Avoid sun exposure during treatment and for at least 7 days after stopping medication. Use a broad-spectrum sunscreen and lip balm with SPF ≥ 50 when outdoors.

3. Anemia management:

If you experience yellowing of skin, fatigue, dizziness, or shortness of breath, be alert for hemolytic anemia and seek medical evaluation promptly.

4. Contraception requirements:

(1) Women must use effective contraception during treatment and for 5 weeks after the last dose.

(2) Men for 3 months.

Proper Storage Conditions for Alectinib

1. Temperature requirements:

Store at temperatures not exceeding 30°C, avoid high heat.

2. Container requirements:

Keep in the original container; do not repackage.

3. Protect from moisture and light:

Keep the medication dry, avoid direct light; the original container provides effective protection.

4. Child safety:

Keep out of reach of children.

5. Note:

Unlike some medications, alectinib has no absolute contraindications, but must still be used strictly as directed by a physician.