Indication:
Alectinib is indicated for treating non-small cell lung cancer (NSCLC) in adult patients who have anaplastic lymphoma kinase (ALK)-positive metastatic NSCLC, and those who have progressed on or cannot tolerate crizotinib.

Administration:
It should be taken with food and swallowed whole without opening or dissolving the capsule.

Adult Dose:
For NSCLC, the recommended dose is 600 mg orally twice daily until disease progression or unacceptable toxicity. Dose reductions are recommended for tolerability issues. It should be temporarily withheld in cases of nephrotoxicity or permanently discontinued in cases of hepatotoxicity.

Renal Dose:
No dose adjustment is required for mild-to-moderate renal impairment. However, alectinib has not been studied in patients with severe renal impairment or end-stage renal disease (ESRD).

Contraindication:
Hypersensitivity to the medication.

Mode of Action:
Alectinib is a tyrosine kinase inhibitor that targets ALK and RET. It inhibits ALK phosphorylation and downstream signaling proteins, decreasing tumor cell viability.

Precaution:
Monitor liver function tests regularly due to reported elevated liver enzymes. Promptly investigate any worsening respiratory symptoms, as interstitial lung disease and pneumonitis have been reported.

Side Effects:
Common side effects include anemia, elevated liver enzymes, fatigue, hyperbilirubinemia, hyperglycemia, constipation, myalgia, and others.

Pregnancy Category Note:
Alectinib can cause fetal harm based on animal studies. Effective contraception is advised during treatment for both males and females. Breastfeeding should be avoided during treatment and for one week after the final dose.

Interaction:
Alectinib may increase plasma concentrations of co-administered substrates of P-glycoprotein (P-gp) or breast cancer resistance protein (BCRP) transporters, such as digoxin, dabigatran, and methotrexate.