Acute kidney injury and long-term renal effects of alectinib in anaplastic lymphoma kinase-positive non-small cell lung carcinoma: a case report
Abstract Background Targeted therapy with anaplastic lymphoma kinase inhibitor alectinib has become standard therapy for selected patients with non-small cell lung carcinoma. Few data are available on the renal effects of alectinib. We report on a case of acute kidney injury in a patient using alect...
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| Format: | Article |
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BMC
2022-09-01
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| Series: | Journal of Medical Case Reports |
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| Online Access: | https://doi.org/10.1186/s13256-022-03532-2 |
| _version_ | 1797998339802791936 |
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| author | Marco van Londen Elizabeth Roosma Stefanie Vogels John W. G. van Putten Wilbert M. T. Janssen |
| author_facet | Marco van Londen Elizabeth Roosma Stefanie Vogels John W. G. van Putten Wilbert M. T. Janssen |
| author_sort | Marco van Londen |
| collection | DOAJ |
| description | Abstract Background Targeted therapy with anaplastic lymphoma kinase inhibitor alectinib has become standard therapy for selected patients with non-small cell lung carcinoma. Few data are available on the renal effects of alectinib. We report on a case of acute kidney injury in a patient using alectinib for less than 2 weeks and on serum sodium and creatinine during long-term use of alectinib. Case presentation A 70-year-old Asian woman was diagnosed with metastasized non-small cell lung carcinoma (cT4N3M1c, stage IV) with echinoderm microtubule-associated protein-like 4 and anaplastic lymphoma kinase gene rearrangement and received alectinib, in two daily doses of 600 mg. Eleven days after the initiation of therapy, she was seen at the emergency department with acute kidney injury. Renal biopsy showed lesions in the proximal tubular epithelial cells. Nine days after alectinib cessation, renal function recovered quickly and reintroduction of alectinib in a reduced dose was tolerated, while withholding metformin, enalapril, and naproxen. In seven other patients, data on estimated glomerular filtration rate showed decreased kidney function at 3 months with stabilization at 6 months. Serum sodium at 3 months increased during alectinib treatment and increased further at 6 months. Conclusions Our data suggest direct or indirect toxic (proximal) tubulopathy due to alectinib with a good prognosis after cessation. Adverse acute renal effects of alectinib may be prevented by avoiding other medication influencing renal hemodynamics, in particular nonsteroidal anti-inflammatory drugs. Without these co-medications, alectinib could be reintroduced in our patient. |
| first_indexed | 2024-04-11T10:47:05Z |
| format | Article |
| id | doaj.art-d2d1a8ce93f94657ba480af6caaee543 |
| institution | Directory Open Access Journal |
| issn | 1752-1947 |
| language | English |
| last_indexed | 2024-04-11T10:47:05Z |
| publishDate | 2022-09-01 |
| publisher | BMC |
| record_format | Article |
| series | Journal of Medical Case Reports |
| spelling | doaj.art-d2d1a8ce93f94657ba480af6caaee5432022-12-22T04:29:01ZengBMCJournal of Medical Case Reports1752-19472022-09-011611510.1186/s13256-022-03532-2Acute kidney injury and long-term renal effects of alectinib in anaplastic lymphoma kinase-positive non-small cell lung carcinoma: a case reportMarco van Londen0Elizabeth Roosma1Stefanie Vogels2John W. G. van Putten3Wilbert M. T. Janssen4Department of Internal Medicine, Martini Hospital GroningenDepartment of Pulmonology, Martini Hospital GroningenDepartment of Internal Medicine, Martini Hospital GroningenDepartment of Pulmonology, Martini Hospital GroningenDepartment of Internal Medicine, Martini Hospital GroningenAbstract Background Targeted therapy with anaplastic lymphoma kinase inhibitor alectinib has become standard therapy for selected patients with non-small cell lung carcinoma. Few data are available on the renal effects of alectinib. We report on a case of acute kidney injury in a patient using alectinib for less than 2 weeks and on serum sodium and creatinine during long-term use of alectinib. Case presentation A 70-year-old Asian woman was diagnosed with metastasized non-small cell lung carcinoma (cT4N3M1c, stage IV) with echinoderm microtubule-associated protein-like 4 and anaplastic lymphoma kinase gene rearrangement and received alectinib, in two daily doses of 600 mg. Eleven days after the initiation of therapy, she was seen at the emergency department with acute kidney injury. Renal biopsy showed lesions in the proximal tubular epithelial cells. Nine days after alectinib cessation, renal function recovered quickly and reintroduction of alectinib in a reduced dose was tolerated, while withholding metformin, enalapril, and naproxen. In seven other patients, data on estimated glomerular filtration rate showed decreased kidney function at 3 months with stabilization at 6 months. Serum sodium at 3 months increased during alectinib treatment and increased further at 6 months. Conclusions Our data suggest direct or indirect toxic (proximal) tubulopathy due to alectinib with a good prognosis after cessation. Adverse acute renal effects of alectinib may be prevented by avoiding other medication influencing renal hemodynamics, in particular nonsteroidal anti-inflammatory drugs. Without these co-medications, alectinib could be reintroduced in our patient.https://doi.org/10.1186/s13256-022-03532-2Acute kidney injuryAlectinibAnaplastic lymphoma kinaseTubular toxicityCase report |
| spellingShingle | Marco van Londen Elizabeth Roosma Stefanie Vogels John W. G. van Putten Wilbert M. T. Janssen Acute kidney injury and long-term renal effects of alectinib in anaplastic lymphoma kinase-positive non-small cell lung carcinoma: a case report Journal of Medical Case Reports Acute kidney injury Alectinib Anaplastic lymphoma kinase Tubular toxicity Case report |
| title | Acute kidney injury and long-term renal effects of alectinib in anaplastic lymphoma kinase-positive non-small cell lung carcinoma: a case report |
| title_full | Acute kidney injury and long-term renal effects of alectinib in anaplastic lymphoma kinase-positive non-small cell lung carcinoma: a case report |
| title_fullStr | Acute kidney injury and long-term renal effects of alectinib in anaplastic lymphoma kinase-positive non-small cell lung carcinoma: a case report |
| title_full_unstemmed | Acute kidney injury and long-term renal effects of alectinib in anaplastic lymphoma kinase-positive non-small cell lung carcinoma: a case report |
| title_short | Acute kidney injury and long-term renal effects of alectinib in anaplastic lymphoma kinase-positive non-small cell lung carcinoma: a case report |
| title_sort | acute kidney injury and long term renal effects of alectinib in anaplastic lymphoma kinase positive non small cell lung carcinoma a case report |
| topic | Acute kidney injury Alectinib Anaplastic lymphoma kinase Tubular toxicity Case report |
| url | https://doi.org/10.1186/s13256-022-03532-2 |
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