Hemolytic anemia caused by alectinib, an Anaplastic Lymphoma Kinase (ALK) inhibitor: A case report

Abstract

Background: Anaplastic Lymphoma Kinase (ALK) inhibitors are tyrosine kinase inhibitors used as molecular-targeted therapy for non-small cell lung cancers (NSCLC) harbouring ALK translocations. Case description: This case report describes a 73-year-old female patient who was started on alectinib for a relapsed lung adenocarcinoma. After 73 weeks she began suffering from fatigue and progressive dyspnea. Laboratory results showed a progressive hemolytic anemia with negative direct Coombs test. An alectinib-induced hemolytic anemia was suspected. Because of her symptomatic anemia and persistent oncological remission, alectinib was discontinued. Hemoglobin and parameters of hemolysis normalised two months later, with lasting oncological near complete response. Discussion: Recently, the first cases of hemolytic anemia secondary to alectinib were described in the literature. Drug-induced hemolytic anemia is a rare condition with an increasing incidence associated with the expanding use of newer small molecule inhibitors for cancer treatment. Conclusion: Hemolytic parameters should be checked if a patient develops a new anemia under treatment with alectinib. Hemolytic anemia generally resolves after treatment cessation, but reappears upon rechallenge.

Keywords

• Case report
• ALK-inhibitor
• Hemolytic anemia
• Alectinib
• Non-small cell lung cancers (NSCLC)