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Alecensa (Alectinib)
What is Alecensa?
Alecensa is an oral anti-cancer or anti-neoplastic medication made of the active ingredient alectinib, available in capsule form. Alecensa interferes with the spread of cancer cells and their growth. This medication is highly selective. Alecensa is indicated for non-small cell lung cancer (NSCLC) identified as anaplastic lymphoma kinase positive. Alecensa is indicated for this type of cancer when it has spread, when previously treated with other medications, or as a monotherapy. This cancer starts at a cellular level and reproduces at a fast pace. NSCLC usually begins at the cells lining the airways, including the bronchi and alveoli.
How does it work?
The active ingredient in Alecensa works by blocking the action of an enzyme called ALK tyrosine kinase and preventing its phosphorylation. A fault in this enzyme encourages cancer cell growth. Alectinib can slow down or stop the growth of cancer. It can also help shrink your cancer and is more successful in inhibiting this enzyme than other medications like crizotinib, for example. Alectinib can withhold activity against many of the mutations associated with resistance to crizotinib. Alectinib penetrates the blood-brain barrier and is metabolized in the liver. The inhibition of the ALK enzyme blocks the downstream activation of activated protein resulting in decreased tumor cell viability through its deactivation.
Dosage
Alecensa contains 150mg of alectinib hydrochloride per capsule.
The recommended dose for adults with non-small cell lung cancer is 600mg twice daily. This equals four capsules twice a day, eight capsules in total.
The recommended dose for a patient with severe liver impairment is three capsules twice daily. This is equivalent to 900mg daily or six capsules in total.
How to take Alecensa?
Alecensa should be taken exactly as prescribed by your doctor. Do not chew, suck, or deconstruct the capsule. Do not dissolve the inner contents of the capsule. Instead, swallow the capsules whole with food at the same time each day.
How to store?
Keep Alecensa out of reach of children and store it in its original packing to protect it from moisture and light—store Alecensa at room temperature.
Overdose
There is no specific antidote when overdosing with Alecensa. If you suspect taking more than the recommended dose of Alecensa, contact the poison control center or call 911 for immediate medical assistance.
Side effects
The most common side effects are:
- Tiredness and weakness
- Constipation
- Swelling of feet, hands, mouth, and eyelids
- Muscle pain
- Low red blood cell count
- High blood sugar levels
- Reduced levels of calcium, sodium, potassium, and phosphate
- Headache
- Change in taste
- Backpain
- Lymphopenia and neutropenia- Low levels of lymphocytes and neutrophils
- Increased sensitivity to sunlight
- Rash
- Weight gain
- Disturbed vision
- Diarrhea
Serious side effects of Alecensa include:
- Liver problems or hepatotoxicity. Your doctor may recommend blood tests every two weeks for the first three months of treatment and then once a month as needed to help keep an eye out for liver injury. You may experience tiredness, loss of appetite, jaundice or yellowing of the skin and eyes, dark urine, itchy skin, nausea, vomiting, right-sided stomach pain, and frequent bleeding or bruising. Speak to your doctor about this.
- Lung inflammation. This side effect can be life-threatening if left untreated. Symptoms are like that of lung cancer. If you notice a cough, fever, or difficulty breathing, speak to your doctor.
- Kidney problems. If you notice a change in the amount or color of your urine, or swelling of the legs and feet, speak to your doctor.
- Slow heartbeat. Consult your doctor if you feel lightheaded, dizzy, or feel faint. Your doctor may check your heart rate and blood pressure during your treatment with Alecensa. Inform your doctor if you take blood pressure medication.
- Muscle pain. If you experience unexplained muscle pain, weakness, or muscle problems, speak to your doctor. Your doctor may recommend regular blood tests while on Alecensa.
- Hemolytic anemia. This refers to the breakdown of healthy red blood cells. Your doctor may interrupt your treatment with Alecensa and carry out blood tests to check for this issue.
- Vision problems. Speak to your doctor if you start seeing floaters or reduced or blurry vision.
- Gastrointestinal perforation. Those with a history of diverticulitis, metastasis of the gastrointestinal tract, or concomitant use of other medication with a risk of gastrointestinal perforation have an increased risk of developing this. Speak to your doctor and be aware of the signs and symptoms of this.
Precautions & Warnings
You should not take Alecensa if you are allergic to its active ingredient or excipients.
If you are being prescribed Alecensa, inform your doctor immediately if you have liver problems, stomach or intestinal problems, lung or breathing problems, slow heartbeat, are pregnant or planning to become, are breastfeeding, or planning to breastfeed.
Inform your doctor before starting Alecensa if you have galactose intolerance, congenital lactase deficiency, or glucose-galactose malabsorption.
Let your doctor know of all prescription, over-the-counter and herbal medications you might be on.
You should monitor your liver tests every two weeks during the first three months on Alecensa and then once a month as your doctor deems fit. These tests will help your doctor determine whether you should withhold the treatment or discontinue it permanently.
Alecensa can cause severe damage to the fetus. Therefore, women of childbearing age should use highly effective contraceptive methods while on Alecensa. In addition, men whose sexual partners have the potential to become pregnant should also use highly effective contraceptive methods. This should last for at least three months after your last dose of Alecensa.
While taking Alecensa, you should avoid prolonged sun exposure and use sunscreen. This should continue for at least seven days after you stop this treatment.
Women should not breastfeed while on Alecensa; this should last for at least a week after the last dose.
Alecensa could interfere with your vision and blood pressure. Therefore, if you feel dizzy, faint, or have difficulty breathing, do not drive or operate machinery.
Alecensa can make your oral contraceptive pill less effective.
Drug Interactions
The following are some medicines that can interact with Alecensa:
- Heart medications like amlodipine and digoxin
- Antibiotics and antifungals like clarithromycin and fluconazole
- HIV medications like atazanavir and ritonavir
- Certain chemotherapy like methotrexate, mitoxantrone, imatinib, and nilotinib
- Treatment for multiple sclerosis-like Teriflunomide and interferon beta 1A
- Sirolimus, cyclosporine, and everolimus- Used after an organ transplant to avoid rejection
- Particular medication used to treat blood clots like dabigatran etexilate
- St John’s Wort- used to treat depression
- Certain medications used to treat seizures and fits like carbamazepine and phenobarbital
- Drugs used to treat tuberculosis like rifampicin and rifabutin
- Medication used to treat depression like nefazodone
Advise your doctor of any prescription, over-the-counter, and herbal remedies you are on.
Contraindications
The medication in Alecensa is contraindicated in:
- Pregnant and breastfeeding women. The active ingredient in Alecensa can harm your baby.
- Individuals with hypersensitivity or known allergy to the active ingredient alectinib or any of the excipients found in Alecensa.
- Individuals with galactose intolerance, congenital lactase deficiency, or glucose-galactose malabsorption since this medication contain lactose.