From spotlight to shadow: ALK inhibitor-induced acute liver failure in a patient with non-small cell lung cancer

Abstract

Novel oncological therapies substantially improved the prognosis of cancer patients. Immunotherapies (immune checkpoint inhibitors) and targeted therapies (tyrosine kinase inhibitors) represent innovative strategies, which have revolutionized cancer patient’s approaches. However, the new treatments may bring additional adverse effects, therefore right selection, close monitoring, and appropriate clinical decisions in the event of a complication are of upmost importance in these patients' management. We present an elderly male patient undergoing treatment with alectinib - anaplastic lymphoma kinase (ALK) inhibitor for metastatic non-small cell lung cancer, who was diagnosed with acute liver failure by drug-induced liver injury, five months after the start of the therapy. After the other possible causes of hepatocellular injury were excluded, the drug was discontinued. Using corticotherapy and supportive measures, the evolution of the patient was favorable. Up to this moment, data showed that alectinib was less associated with liver function abnormalities compared to other ALK inhibitors, however most commonly of mild or moderate grade of severity, especially in the first two months of treatment. The case we report presented acute onset liver failure, with a relatively late occurrence during alectinib therapy. Timely recognition may improve patients’ prognosis, and monitoring must be carried out rigorously. Awareness and effective interdisciplinary communication among medical specialties play a pivotal role in the comprehensive care of cancer patients.