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CC BY 4.0 · Indian J Med Paediatr Oncol
DOI: 10.1055/s-0045-1810058
Case Report with Review of Literature

Alectinib-Induced Hemolysis in a Case of ALK-Positive Metastatic Lung Adenocarcinoma: A Case Report with Review of Literature

Suparna Ajit Rao
1   Department of Medical Oncology, PD Hinduja National Hospital and Medical Research Centre, Mahim, Mumbai, Maharashtra, India
,
Tejas Radadiya
1   Department of Medical Oncology, PD Hinduja National Hospital and Medical Research Centre, Mahim, Mumbai, Maharashtra, India
,
Vidhisha Mahajan
2   Section of Hematology, Department of Laboratory Medicine, PD Hinduja National Hospital and Medical Research Centre, Mahim, Mumbai, Maharashtra, India
,
Farah Jijina
3   Department of Haematology, PD Hinduja National Hospital and Medical Research Centre, Mahim, Mumbai, Maharashtra, India
,
Asha Kapadia C.
4   Department of Medical Oncology, Department of Internal Medicine, PD Hinduja National Hospital and Medical Research Centre, Mahim, Mumbai, Maharashtra, India
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Abstract

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.

Keywords

alectinib - hemolysis - lung cancer - case report

Patient's Consent

Written informed consent was obtained from the patient prior to the study.




Publication History

Article published online:
10 July 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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