The National Institute for Health and Care Excellence (NICE) has recommended alectinib (Alecensa) as a treatment option for adults with anaplastic lymphoma kinase (ALK)-positive advanced non-small cell lung cancer (NSCLC).
It is essential to perform a validated ALK assay to establish ALK-positive NSCLC status before starting alectinib therapy. Recommended dose for alectinib is 600 mg twice daily (1200 mg total daily dose) to be administered with food. Occurrence of adverse events may require dose reduction, temporary interruption or discontinuation of therapy. Dose reduction should be carried out in steps of 150 mg twice daily depending on tolerability. Permanent discontinuation is advised in patients unable to tolerate 300 mg twice daily dose.
Individuals with ALK-positive advanced NSCLC are usually treated with crizotinib. Clinical trial data show that alectinib to be more effective than crizotinib in delaying disease progression. However, there is limited evidence to tell how long alectinib extends survival compared with crizotinib.
The drug is to be used only when provided by the company in agreement with the commercial arrangement. The recommendations should not affect patients whose treatment with the drug was started before publication of the guidance.
