Key result
Concurrent use of alectinib and apixaban resulted in unexpectedly high apixaban plasma concentrations, requiring a stepwise dose reduction to 25% of the original dose.
Why the study?
DOAC plasma concentrations are potentially affected by drug-drug interactions with anticancer therapies via CYP3A4, P-gp, and/or BCRP pathways.
Does concurrent use of alectinib and apixaban affect apixaban plasma concentrations in a patient with NSCLC?
Case Report (n=1)
Does concurrent use of alectinib and apixaban affect apixaban plasma concentrations in a patient with NSCLC?
Concurrent use of alectinib and apixaban can lead to unexpectedly high apixaban plasma concentrations, necessitating dose reduction and therapeutic drug monitoring.
Warrants TDM and dose caution with alectinib-apixaban; leaves open systematic interaction studies.
Plasma concentrations of direct oral anticoagulants (DOAC) are potentially affected because of drug-drug interactions (DDI) with anticancer treatment as a result of inhibition or induction of CYP3A4, p-glycoprotein (P-gp) and/or Breast Cancer Resistance Protein (BCRP) interactions.Here, we present a 78-year-old patient with non-small cell lung cancer (NSCLC) receiving treatment with alectinib concurrent with apixaban as prophylactic treatment of recurrent thrombophlebitis. Given the unexpected high apixaban plasma concentrations, the apixaban dose was reduced stepwise to 25% of its original dose in order to achieve values within the on-therapy reference range. This case demonstrates that monitoring DOAC plasma concentrations may be indicated when DOACs are used concurrently with alectinib.
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Gulikers et al. (2022) conducted a case report in Non-small cell lung cancer (NSCLC) (n=1). Alectinib concurrent with apixaban was evaluated on Apixaban plasma concentrations. Concurrent use of alectinib and apixaban resulted in unexpectedly high apixaban plasma concentrations, requiring a stepwise dose reduction to 25% of the original dose.
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