From the Research
For patients receiving brain radiotherapy while on alectinib, it is generally recommended to temporarily discontinue alectinib for 3-5 days before and after radiotherapy. This recommendation is based on the need to minimize the risk of radiation recall phenomenon and potential increased toxicity from the combination of radiation and the tyrosine kinase inhibitor, as suggested by various studies 1, 2, 3, 4, 5. The temporary discontinuation allows for radiation to work effectively while minimizing overlapping toxicities. Some studies have shown that alectinib can be safely used in combination with thoracic radiotherapy, without synergistic reinforcement in cellular toxicity 5. However, the exact timing of discontinuation should be personalized to each clinical situation, taking into account individual patient factors, radiation dose and fractionation schedule, and the treating physician's assessment of risks versus benefits. Patients should not stop alectinib without specific instructions from their oncologist. Key considerations include:
- Alectinib is a highly selective ALK inhibitor used for ALK-positive non-small cell lung cancer
- Concurrent use with radiation may enhance radiation-induced inflammation in the brain tissue
- Temporary interruption allows for radiation to work effectively while minimizing overlapping toxicities
- Individual patient factors, radiation dose and fractionation schedule, and the treating physician's assessment of risks versus benefits should be taken into account when deciding on the timing of discontinuation.