Switching to an alternative ALK-inhibitor after alectinib-induced pneumonitis resulted in resolution of this adverse event

Abstract

The management of metastatic non-small cell lung cancer (NSCLC) has largely shifted over the past several decades from cytotoxic chemotherapy towards targeted therapy for patients with particular genetic driver mutations, such as epidermal growth factor receptor mutations and the abnormal fusion of the anaplastic lymphoma kinase (ALK) gene. Interstitial lung disease (ILD)/pneumonitis remains one of the rare, yet serious, adverse events reported with each of the small molecule inhibitors that target ALK. The optimal management strategy for patients who develop this adverse effect is not known and little information is available regarding the efficacy of switching to an alternate ALK-inhibitor in the setting of drug-induced ILD/pneumonitis. This report describes the clinical course a patient who developed ILD/pneumonitis while receiving alectinib for treatment of ALK-rearranged NSCLC. Alectinib was subsequently discontinued and ceritinib was initiated, which resulted in resolution of ILD/pneumonitis and continued response to therapy. This report adds to the available literature and demonstrates that utilizing an alternative ALK-inhibitor may be a potential management strategy for drug-induced ILD/pneumonitis that allows patients to continue to receive these effective therapies.

Keywords

• Interstitial lung disease
• Pneumonitis
• Drug-induced pneumonitis
• ALK-inhibitor induced pneumonitis