The Drug-Induced Respiratory Disease Website

Alectinib

Pneumonitis (ILD)

Or 'ILD'. (Fr: PnP subaiguë). A.k.a. pulmonary infiltrates. Generally bilateral and symmetrical. Gradual onset. Consistent with but not specific for an NSIP-c pattern on pathology. Less- dense, severe, acute and diffuse than pattern Ia. Lacks the features of ARDS that may accompany pattern Ia. Can be in the form of disseminated linear, reticulonodular, miliary or patchy opacities. BAL is indicated to separate this pattern from PIE (Ic) or DAH (IIIa). Acute chest pain can be at the forefront. A search for microorganisms including Pneumocystis (stains, PCR) is indicated. On pathology (although not many cases undergo a confirmatory lung biopsy), there is interstitial inflammation and a more or less dense cellular interstitial cellular infiltrate (NSIP-c). Fibrosis, alveolar edema and/or a reactive epithelium denote those cases resulting from with antineoplastic chemotherapy agents. The frontier between patterns Ia and I b can be difficult to draw, so please check drugs under both Ia and Ib. Patients may quickly shift from pattern Ib to Ia particularly if the the causal drug is inappropriately continued. Prompt withdrawal must be considered, underlying disease permitting, and can be therapeutic.

Publications

Bochtler T, Christopoulos P, Schlamp K, Winkler F, Krämer A

Management of a Pregnant ALK-Positive Lung Cancer Patient With Alectinib-Induced Pneumonitis and Bilateral Globus Pallidus Necrosis Postpartum.

Clinical lung cancer 2024 Jan;25;72-76 — 2024 Jan — 72-76

Chen X, Xia D, Jiang X, Cao L, Ryu JH, Hu X

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

Frontiers in pharmacology 2022;13;944685 — 2022 — 944685

Hwang A, Iskandar A, Dasanu CA

Successful re-introduction of alectinib after inducing interstitial lung disease in a patient with lung cancer.

Journal of oncology pharmacy practice : official publication of the International Society of Oncology Pharmacy Practitioners 2018 Dec 20;;1078155218820580 — 2018 Dec 20 — 1078155218820580

Nitawaki T, Sakata Y, Kawamura K, Ichikado K

Case report: continued treatment with alectinib is possible for patients with lung adenocarcinoma with drug-induced interstitial lung disease.

BMC pulmonary medicine 2017 Dec 06;17;173 — 2017 Dec 06 — 173

Pellegrino B, Facchinetti F, Bordi P, Silva M, Gnetti L, Tiseo M

Lung Toxicity in Non-Small-Cell Lung Cancer Patients Exposed to ALK Inhibitors: Report of a Peculiar Case and Systematic Review of the Literature.

Clinical lung cancer 2018 03;19;e151-e161 — 2018 03 — e151-e161

Yamamoto Y, Okamoto I, Otsubo K, Iwama E, Hamada N, Harada T, Takayama K, Nakanishi Y

Severe acute interstitial lung disease in a patient with anaplastic lymphoma kinase rearrangement-positive non-small cell lung cancer treated with alectinib.

Investigational new drugs 2015 Oct;33;1148-50 — 2015 Oct — 1148-50

Ikeda S, Yoshioka H, Arita M, Sakai T, Sone N, Nishiyama A, Niwa T, Hotta M, Tanaka T, Ishida T

Interstitial lung disease induced by alectinib (CH5424802/RO5424802).

Japanese journal of clinical oncology 2015 Feb;45;221-4 — 2015 Feb — 221-4

Diagnosing DIRD