OncoTargets and Therapy (May 2021)
Successful Treatment with Ensartinib After Alectinib-induced Hyperbilirubinemia in ALK-Positive NSCLC
Abstract
Ling Peng,1,* Kui Xiao,2,* Jian Cui,3 Xiang-Hua Ye,4 Yong-Chang Zhang,5 Li Mao,6 Giovanni Selvaggi,7 Jennifer Yen,8 Justin Stebbing9 1Department of Pulmonary and Critical Care Medicine, Zhejiang Provincial People’s Hospital, Hangzhou, Zhejiang Province, People’s Republic of China; 2Department of Pulmonary and Critical Care Medicine, The Second Xiangya Hospital, Central South University, Changsha, Hunan Province, People’s Republic of China; 3Shanghai BioGenius Bioinformatics Institute, Shanghai, People’s Republic of China; 4Department of Radiotherapy, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, People’s Republic of China; 5Department of Medical Oncology, Lung Cancer and Gastrointestinal Unit, Hunan Cancer Hospital, The Affiliated Cancer Hospital of Xiangya School of Medicine, Changsha, Hunan, People’s Republic of China; 6Betta Pharmaceuticals, Hangzhou, People’s Republic of China; 7X-Covery Holdings, Palm Beach Gardens, FL, USA; 8Guardant Health, Inc., Redwood City, CA, USA; 9Division of Cancer, Department of Surgery and Cancer, Imperial College London, London, UK*These authors contributed equally to this workCorrespondence: Ling PengDepartment of Pulmonary and Critical Care Medicine, Zhejiang Provincial People’s Hospital, No. 158 Shangtang Road, Hangzhou, Zhejiang Province, People’s Republic of ChinaTel/Fax +86-571-85893509Email [email protected]: Alectinib is approved for the treatment of advanced non-small-cell lung cancer (NSCLC) harboring ALK rearrangements. Although generally well tolerated, alectinib can cause serious or life-threatening side effects.Case Presentation: Here, we report a case of a patient with NSCLC with an EML4-ALK fusion and was treated with alectinib but who developed grade 4 hyperbilirubinemia after five months on therapy. Alectinib was discontinued, and an artificial liver support system (ALSS) was used with an impressive decline in bilirubin levels. After two months drug-free, the patient experienced disease progression. Ensartinib was initiated as second-line treatment with a best response of stable disease after three months of therapy with no evidence of hyperbilirubinemia.Conclusion: This is the first report of ensartinib treatment after alectinib-induced hyperbilirubinemia which was successfully relieved by ALSS treatment and targeted drug cessation.Keywords: ensartinib, alectinib, hyperbilirubinemia, NSCLC, ALK
