Introduction

With the rise of precision medicine in oncology, targeted therapies are increasingly used to treat cancers with actionable mutations. Alectinib, a selective anaplastic lymphoma kinase (ALK) inhibitor, is currently approved as a first-line therapy option for patients with metastatic ALK-rearranged non–small cell lung cancer (NSCLC). Alectinib-associated cutaneous eruption, most commonly described as a morbilliform or maculopapular erythematous rash, is a known adverse effect of alectinib. Although the majority of rashes are classified as Grade 1–2 according to the National Cancer Institute Common Terminology Criteria for Adverse Events (NCI CTCAE), rare Grade 3 reactions have been reported and may require treatment interruption or discontinuation.However, standardized guidelines for reintroduction after rash onset are lacking. Most published case reports describe restarting alectinib at very low doses followed by slow up titration, with few patients tolerating a return close to the full standard dose of 600 mg twice daily. Our case series highlights an alternative approach: using a high-dose oral glucocorticoid taper alongside reintroduction of alectinib at a moderately reduced dose, without the need for slow desensitization.

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