Alectinib-Induced Hemolysis in a Case of ALK-Positive Metastatic Lung Adenocarcinoma: A Case Report with Review of Literature
This is a case report of how we tumbled upon anemia due to drug-related hemolysis, a rare side effect of alectinib, which is a primary drug used in ALK-positive lung cancer. A 78-year-old male patient with history of surgery and concurrent chemoradiation for a primary adenocarcinoma lung in 2013 pre...
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| author | Suparna Ajit Rao Tejas Radadiya Vidhisha Mahajan Farah Jijina Asha Kapadia C. |
| author_facet | Suparna Ajit Rao Tejas Radadiya Vidhisha Mahajan Farah Jijina Asha Kapadia C. |
| author_sort | Suparna Ajit Rao |
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| description | This is a case report of how we tumbled upon anemia due to drug-related hemolysis, a rare side effect of alectinib, which is a primary drug used in ALK-positive lung cancer. A 78-year-old male patient with history of surgery and concurrent chemoradiation for a primary adenocarcinoma lung in 2013 presented with a systemic recurrence of the lung cancer in October 2022. Molecular testing of the biopsy at recurrence revealed an ALK-positive status. He was started on alectinib 600 mg twice a day, a tyrosine kinase inhibitor in November 2022. His disease had a very good response to the drug; however, he was noted to have a gradual drop in hemoglobin and a mild indirect hyperbilirubinemia. Subsequently, alectinib dosage was interrupted and investigations were performed to rule out the commonly prevalent causes of anemia, such as iron deficiency, vitamin B12, and folate, which were found to be normal. Upper and lower gastrointestinal endoscopy, Coombs test, serum lactate dehydrogenase, and haptoglobin levels were normal. The peripheral smear evaluated during his admission showed a picture of hemolysis. On reviewing literature, it was deduced that this was related to alectinib. The hemolysis in this case, like others, was occult and subclinical. This is the first such case from India, and it highlights the need for an experienced hematopathologist to clinch such a diagnosis. On follow-up, his drug has been changed to lorlatinib and his hemoglobin has recovered to normal levels. |
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| spelling | doaj-art-da66bd7894154531938f1555440f7edb2025-08-20T02:35:43ZengThieme Medical and Scientific Publishers Pvt. Ltd.Indian Journal of Medical and Paediatric Oncology0971-58510975-212910.1055/s-0045-1810058Alectinib-Induced Hemolysis in a Case of ALK-Positive Metastatic Lung Adenocarcinoma: A Case Report with Review of LiteratureSuparna Ajit Rao0Tejas Radadiya1Vidhisha Mahajan2Farah Jijina3Asha Kapadia C.4Department of Medical Oncology, PD Hinduja National Hospital and Medical Research Centre, Mahim, Mumbai, Maharashtra, IndiaDepartment of Medical Oncology, PD Hinduja National Hospital and Medical Research Centre, Mahim, Mumbai, Maharashtra, IndiaSection of Hematology, Department of Laboratory Medicine, PD Hinduja National Hospital and Medical Research Centre, Mahim, Mumbai, Maharashtra, IndiaDepartment of Haematology, PD Hinduja National Hospital and Medical Research Centre, Mahim, Mumbai, Maharashtra, IndiaDepartment of Medical Oncology, Department of Internal Medicine, PD Hinduja National Hospital and Medical Research Centre, Mahim, Mumbai, Maharashtra, IndiaThis is a case report of how we tumbled upon anemia due to drug-related hemolysis, a rare side effect of alectinib, which is a primary drug used in ALK-positive lung cancer. A 78-year-old male patient with history of surgery and concurrent chemoradiation for a primary adenocarcinoma lung in 2013 presented with a systemic recurrence of the lung cancer in October 2022. Molecular testing of the biopsy at recurrence revealed an ALK-positive status. He was started on alectinib 600 mg twice a day, a tyrosine kinase inhibitor in November 2022. His disease had a very good response to the drug; however, he was noted to have a gradual drop in hemoglobin and a mild indirect hyperbilirubinemia. Subsequently, alectinib dosage was interrupted and investigations were performed to rule out the commonly prevalent causes of anemia, such as iron deficiency, vitamin B12, and folate, which were found to be normal. Upper and lower gastrointestinal endoscopy, Coombs test, serum lactate dehydrogenase, and haptoglobin levels were normal. The peripheral smear evaluated during his admission showed a picture of hemolysis. On reviewing literature, it was deduced that this was related to alectinib. The hemolysis in this case, like others, was occult and subclinical. This is the first such case from India, and it highlights the need for an experienced hematopathologist to clinch such a diagnosis. On follow-up, his drug has been changed to lorlatinib and his hemoglobin has recovered to normal levels.http://www.thieme-connect.de/DOI/DOI?10.1055/s-0045-1810058alectinibhemolysislung cancercase report |
| spellingShingle | Suparna Ajit Rao Tejas Radadiya Vidhisha Mahajan Farah Jijina Asha Kapadia C. Alectinib-Induced Hemolysis in a Case of ALK-Positive Metastatic Lung Adenocarcinoma: A Case Report with Review of Literature Indian Journal of Medical and Paediatric Oncology alectinib hemolysis lung cancer case report |
| title | Alectinib-Induced Hemolysis in a Case of ALK-Positive Metastatic Lung Adenocarcinoma: A Case Report with Review of Literature |
| title_full | Alectinib-Induced Hemolysis in a Case of ALK-Positive Metastatic Lung Adenocarcinoma: A Case Report with Review of Literature |
| title_fullStr | Alectinib-Induced Hemolysis in a Case of ALK-Positive Metastatic Lung Adenocarcinoma: A Case Report with Review of Literature |
| title_full_unstemmed | Alectinib-Induced Hemolysis in a Case of ALK-Positive Metastatic Lung Adenocarcinoma: A Case Report with Review of Literature |
| title_short | Alectinib-Induced Hemolysis in a Case of ALK-Positive Metastatic Lung Adenocarcinoma: A Case Report with Review of Literature |
| title_sort | alectinib induced hemolysis in a case of alk positive metastatic lung adenocarcinoma a case report with review of literature |
| topic | alectinib hemolysis lung cancer case report |
| url | http://www.thieme-connect.de/DOI/DOI?10.1055/s-0045-1810058 |
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