Successful Drug Rechallenge Following Severe Acute Alectinib-induced Interstitial Lung Disease in a Patient With Advanced ALK-rearranged Lung Adenocarcinoma

Case report: Indolent drug-related pneumonitis with alectinib therapy in the treatment of non-small cell lung cancer

“…The drug labeling of alectinib recommends immediate discontinuation of the drug in cases of suspected DRP, and permanent discontinuation of the drug if no other underlying causes of ILD or non-infectious pneumonia are identified. However, in previous reports, patients did not redevelop DRP after restarting or reducing the dose of alectinib (( Nitawaki et al, 2017 ); ( Gadotti et al, 2021 ); ( Huang et al, 2021 ); ( Hwang et al, 2019 )). Furthermore, there were several case reports describing the successful use of crizotinib or lorlatinib in patients with ALK-rearranged NSCLC who have recovered from DRP secondary to alectinib therapy [( Myall et al, 2021 ); ( Zhu et al, 2021 )].…”

“…To our knowledge, this is the first reported case of alectinib-related ILD that manifested an indolent onset and gradual progression during continued alectinib therapy but completely resolved after discontinuation of alectinib. In most Frontiers in Pharmacology frontiersin.org other reports, alectinib was discontinued immediately after the occurrence of ILD, and the ILD improved sequentially (Table 1) (Ikeda et al, 2015;Yamamoto et al, 2015;Nitawaki et al, 2017;Gadotti et al, 2021;Huang et al, 2021;Myall et al, 2021;Zhu et al, 2021). Two patients were reported to have continued alectinib treatment after developing asymptomatic ILD without exacerbation of ILD ( (Nitawaki et al, 2017); (Hwang et al, 2019)).…”

A non-small cell lung carcinoma patient responded to crizotinib therapy after alectinib-induced interstitial lung disease

“…一般来说，一旦怀疑药物相关ILD，应立即停用可能引起该病的药物，并给予积极的皮质类固醇治疗和对症支持治疗 ［ 6 ］ 。在临床实践中，医生们通常不愿意使用与导致ILD相关药物的类似药物。对于接受 ALK -TKI治疗后发生ILD的患者尚无标准的后续治疗方案。目前已有一些研究报道了发生 ALK -TKI相关ILD后的NSCLC患者成功使用 ALK -TKI进行再治疗的案例 ［ 7 - 11 ］ 。如有文献报道发生阿来替尼相关ILD后成功使用劳拉替尼或克唑替尼进行治疗的案例 ［ 12 - 14 ］ ；还有一些案例报道了发生克唑替尼、色瑞替尼或布加替尼相关ILD后，重新使用相同 ALK -TKI ［ 15 - 22 ］ 或其他 ALK -TKI ［ 23 - 28 ］ 均无ILD的复发。然而，值得注意的是，有一例使用阿来替尼后出现ILD的NSCLC患者继续使用阿来替尼后ILD进展 ［ 29 ］ ；另有4例发生克唑替尼相关ILD的患者在重新使用克唑替尼后出现了ILD复发 ［ 19 - 20 ］ 。…”