Drug interaction profile of TKI alectinib allows effective and safe treatment of ALK plus lung cancer in the kidney transplant recipient

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Authors

BÍLEK Ondřej HOLÁNEK Miloš JUŘICA Jan STEPANKOVA Sona VASINA Jiri SELINGEROVÁ Iveta POPRACH Alexandr BOŘILOVÁ Simona KAZDA Tomáš KISS Igor ZDRAŽILOVÁ DUBSKÁ Lenka

Year of publication 2021
Type Article in Periodical
Magazine / Source International Immunopharmacology
MU Faculty or unit

Faculty of Medicine

Citation
Web https://www.sciencedirect.com/science/article/pii/S1567576921006482?via%3Dihub
Doi http://dx.doi.org/10.1016/j.intimp.2021.108012
Keywords ALK plus NSCLC; Kidney transplant; Alectinib; Crizotinib; cyclosporine A; Drug interaction
Description ALK targeting with tyrosine kinase inhibitors (TKIs) is a highly potent treatment option for the therapy of ALK positive non-small cell lung cancer (NSCLC). However, pharmacokinetics of TKIs leads to clinically significant drug interactions, and the interfering co-medication may hamper the anti-cancer therapeutic management. Here, we present for the first time a drug interaction profile of ALK-TKIs, crizotinib and alectinib, and immunosuppressive agent cyclosporine A in kidney transplant recipients diagnosed with ALK+ lung cancer. Based on therapeutic drug monitoring of cyclosporin A plasma level, the dose of cyclosporine A has been adjusted to achieve a safe and effective therapeutic level in terms of both cancer treatment and kidney transplant condition. Particularly, 15 years upon the kidney transplantation, the stage IV lung cancer patient was treated with the 1st-line chemotherapy, the 2nd-line ALK-TKI crizotinib followed by ALK-TKI alectinib. The successful therapy with ALK-TKIs has been continuing for more than 36 months, including the period when the patient was treated for COVID-19 bilateral pneumonia. Hence, the therapy of ALK+ NSCLC with ALK-TKIs in organ transplant recipients treated with cyclosporine A may be feasible and effective.
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