Classification: kinase inhibitor
About: Alectinib (Alecensa®)
A kinase is an enzyme that promotes cell growth. There are many types of kinases, which control different phases of cell growth. By blocking a particular enzyme from working, this medication can slow the growth of cancer cells.
Alectinib works by targeting and blocking receptors found on the cancer cells called an anaplastic lymphoma kinase (ALK). In some cancers, this receptor is overactive, causing cells to grow and divide too fast. By inhibiting ALK, this medication can slow or stop tumor growth. Your oncology team will test your tumor for this abnormality, which must be present in order to receive the medication.
How to Take Alectinib
Alectinib is taken by mouth, in capsule form, with the typical dose being 600 mg twice a day. This medication should be taken with food. Swallow the capsules whole; do not crush, chew, break or open the capsules. If you miss a dose, do not take two doses to make up for a missed dose. If you vomit after taking your dose, do not take another dose. Take the next dose at its normally scheduled time. Consult with your pharmacist or provider if you are having trouble swallowing the medication.
The capsules are 150mg each, meaning you will need to take a number of capsules to achieve the full dose. It is important to make sure you are taking the correct amount of medication every time. Before every dose, check that what you are taking matches what you have been prescribed.
Storage and Handling
Store your medication in the original, labeled container at room temperature and in a dry location (unless otherwise directed by your healthcare provider or pharmacist). This medication should not be stored in a pillbox. Keep containers out of reach of children and pets.
If a caregiver prepares your dose for you, they should consider wearing gloves or pour the pills directly from their container into the cap, a small cup, or directly into your hand. They should avoid touching the pills. They should always wash their hands before and after giving you the medication. Pregnant or nursing women should not prepare the dose for you. Ask your oncology team where to return any unused medication for disposal. Do not flush down the toilet or throw in the trash.
Where do I get this medication?
Alectinib is available through select specialty pharmacies. Your oncology team will work with your prescription drug plan to identify an in-network specialty pharmacy for distribution of this medication and shipment directly to your home.
This medication may be covered under your prescription drug plan. Patient assistance may be available to qualifying individuals depending upon prescription drug coverage. Co-pay cards, which reduce the patient co-pay responsibility for eligible commercially (non-government sponsored) insured patients, may also be available. Your care team can help you find these resources, if they are available.
Possible Side Effects of Alectinib
There are a number of things you can do to manage the side effects of alectinib. Talk to your care team about these recommendations. They can help you decide what will work best for you. These are some of the most common or important side effects:
Fatigue is very common during cancer treatment and is an overwhelming feeling of exhaustion that is not usually relieved by rest. While on cancer treatment, and for a period after, you may need to adjust your schedule to manage fatigue. Plan times to rest during the day and conserve energy for more important activities. Exercise can help combat fatigue; a simple daily walk with a friend can help. Talk to your healthcare team for helpful tips on dealing with this side effect.
There are several things you can do to prevent or relieve constipation. Include fiber in your diet (fruits and vegetables), drink 8-10 glasses of non-alcoholic fluids a day, and keep active. A stool softener once or twice a day may prevent constipation. If you do not have a bowel movement for 2-3 days, you should contact your healthcare team for suggestions to relieve the constipation.
This medication can cause swelling (edema) in the face, especially around the eyes, and extremities. This can be a sign of other problems, so be sure to report any abnormal swelling to your healthcare team for further evaluation.
Low Red Blood Cell Count (Anemia)
Your red blood cells are responsible for carrying oxygen to the tissues in your body. When the red cell count is low, you may feel tired or weak. You should let your oncology care team know if you experience any shortness of breath, difficulty breathing or pain in your chest. If the count gets too low, you may receive a blood transfusion.
High Blood Sugar
This medication can cause elevated blood sugar levels in patients with and without diabetes. Your oncology care team will monitor your blood sugar. If you develop increased thirst, urination or hunger, blurry vision, headaches or your breath smells like fruit, notify your healthcare team. Diabetics should monitor their blood sugar closely and report elevations to the healthcare team.
This medication can make your skin more sensitive to the sun especially while taking the medication and for the seven days following your last dose. This sensitivity can result in severe sunburn or rash. Sun sensitivity can last even after chemotherapy is completed. Avoid the sun between 10-2pm, when it is strongest. Wear sunscreen (at least SPF 30 with UVA/UVB protection) everyday and reapply when in the sun for extended periods of time); wear sunglasses with UVA/UVB protection, a hat and long sleeves/pants to protect your skin and seek out shade whenever possible.
Less common, but important side effects can include:
- Liver Toxicity: This medication can cause liver toxicity, which your provider will monitor for using blood tests called liver function tests. Notify your healthcare provider if you notice yellowing of the skin or eyes, feeling more tired than usual, feeling less hungry than usual, skin is itchy, nausea, bleeding or bruising more than normal, your urine appears dark or brown or pain in your abdomen, as these can be signs of liver toxicity. You will have lab work to monitor your liver function every 2 weeks for the first 3 months of treatment and then as indicated by your provider.
- Interstitial Lung Disease: Patients can develop inflammation, stiffness and damage of the lungs while taking this medication. Notify your healthcare provider right away if you develop any new or worsening symptoms, including shortness of breath, trouble breathing, cough or fever.
- Bradycardia: Bradycardia is a lower than normal heart rate, which can be a serious problem. Report any dizziness, light-headedness and fainting to your provider immediately. Your provider will monitor your heart rate and blood pressure regularly during therapy.
- Muscle Pain and Weakness: This pain can be associated with damage to the muscles, which can become severe. Your provider will do blood tests to monitor your creatine phosphokinase level every two weeks for the first month of treatment and then as needed to check for muscle damage. If you are experiencing any unexplained muscle pain, tenderness or weakness, notify your provider right away.
Exposure of an unborn child to this medication could cause birth defects, so you should not become pregnant or father a child while on this medication. Effective birth control is necessary during treatment and for at least 1 week for women and 3 months for men after treatment. Even if your menstrual cycle stops or you believe you are not producing sperm, you could still be fertile and conceive. You should not breastfeed while taking this medication or for one week after your last dose.