Successful oral desensitization against skin rash induced by alectinib in a patient with anaplastic lymphoma kinase-positive lung adenocarcinoma: A case report

Shirasawa, Masayuki; Kubota, Minoru; Harada, Shinji; Niwa, Hideyuki; Kusuhara, Seiichiro; Kasajima, Masashi; Hiyoshi, Yasuhiro; Ishihara, Mikiko; Igawa, Satoshi; Masuda, Noriyuki

doi:10.1016/j.lungcan.2016.06.017

Cited by 15 publications

(19 citation statements)

References 15 publications

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“…10 Reintroducing alectinib with a desensitization protocol is not well-established. 7 , 11 A literature review identified four cases ( Table 2 ), of which three outlined their desensitization protocol. 7 – 9 In all four, the skin rash occurred 10–14 days of starting alectinib and did not reoccur after the desensitization protocol.…”

Section: Discussionmentioning

confidence: 99%

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Patients with high-grade alectinib-induced skin rash: How do we desensitize these patients? A case report and review of literature

Seegobin

Majeed

Lou

et al. 2020

SAGE Open Medical Case Reports

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With the advent of targeted therapy for non-small-cell lung cancer, there are many new available treatment options for patients whose cancer harbors an actionable mutation or alteration. These new medications come with numerous side effects, for some of which, the management is not well defined. Alectinib is a second-generation tyrosine kinase inhibitor approved for stage-IV lung adenocarcinoma with anaplastic lymphoma kinase gene rearrangement. Severe (⩾Grade 3) skin rash is a rare side effect of alectinib. Reintroducing alectinib in patients with severe skin rash is not well defined in the medical literature. While other case reports have outlined their approach and desensitization protocol, the maximum dose that patients were titrated up to in a desensitization protocol was 300 mg twice daily. Here, we report a case of Grade 3 skin rash secondary to alectinib, and our experience in managing the rash and reintroducing alectinib with a unique desensitization protocol to a max of 600 mg twice daily (full dose). This case could provide further guidance to oncologists managing patients with this adverse event and may aid in reducing concerns to both patients and physicians about recurrence of skin rash at the maximum dose.

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Section: Discussionmentioning

confidence: 99%

“…To our knowledge, only three case reports outlined desensitization protocols. 7 – 9 Here, we report a case of Grade 3 skin rash due to alectinib and our desensitization protocol.…”

Section: Introductionmentioning

confidence: 99%

Patients with high-grade alectinib-induced skin rash: How do we desensitize these patients? A case report and review of literature

Seegobin

Majeed

Lou

et al. 2020

SAGE Open Medical Case Reports

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“…To the best of our knowledge, two cases of delayed skin hypersensitivity to alectinib have been reported ( Table 1 ). 5 , 7 In both cases, patients were treated with oral desensitization for 9 and 14 days in the inpatient monitored setting, respectively. 5 While desensitization seemed effective in the reported cases, we did not believe that this was an appropriate course for our patient.…”

Section: Discussionmentioning

confidence: 99%

“… 5 , 7 In both cases, patients were treated with oral desensitization for 9 and 14 days in the inpatient monitored setting, respectively. 5 While desensitization seemed effective in the reported cases, we did not believe that this was an appropriate course for our patient. First, there has been no consensus of the utility and risk/benefit ratio of desensitization for delayed hypersensitivity.…”

Section: Discussionmentioning

confidence: 99%

“…Previously, only desensitization was reported although its role in delayed hypersensitivity remains controversial and usually requires close inpatient monitor. 5 , 6 In the present study, we report a case of alectinib-induced type IV delayed hypersensitivity presenting with an extensive skin rash and high fever, after obtaining a written informed consent from the patient to publish the case details and accompanying images. This serious toxicity was successfully managed in this case by a brief course of prednisone and switching treatment to brigatinib which demonstrated excellent activity.…”

Section: Introductionmentioning

confidence: 96%

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Hypersensitivity in ALK-positive lung cancers exposed to ALK inhibitors: a case of successful switch to an alternative ALK inhibitor and systematic review of the literature

Deng

Sharma

Ravera

et al. 2018

LCTT

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Alectinib can cause rare, but severe hypersensitivity. The cross-reactivity between different ALK inhibitors is unknown and desensitization is the only reported management. We hereby report the first case of severe delayed hypersensitivity developed in a lung cancer patient treated by alectinib, who was successfully managed by switching to brigatinib, another ALK inhibitor. The patient achieved excellent anti-tumor response to brigatinib. Our case provides an alternative and safe strategy in patients with alectinib-related hypersensitivity.

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Dermatologic Adverse Effects of Anticancer Therapy III: Targeted and Immunotherapies

Dang

Thompson

Liu

et al. 2021

Dermato-Oncology Study Guide

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Successful oral desensitization against skin rash induced by alectinib in a patient with anaplastic lymphoma kinase-positive lung adenocarcinoma: A case report

Cited by 15 publications

References 15 publications

Patients with high-grade alectinib-induced skin rash: How do we desensitize these patients? A case report and review of literature

Patients with high-grade alectinib-induced skin rash: How do we desensitize these patients? A case report and review of literature

Hypersensitivity in ALK-positive lung cancers exposed to ALK inhibitors: a case of successful switch to an alternative ALK inhibitor and systematic review of the literature

Dermatologic Adverse Effects of Anticancer Therapy III: Targeted and Immunotherapies

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