Alectinib May Be More Effective When Taken With Larger Meals in Some Patients With NSCLC

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Researchers have found that when the small molecule kinase inhibitor alectinib was taken in combination with a fuller breakfast or lunch, it resulted in significantly higher drug concentrations than when taken with a low-fat breakfast in patients with non–small cell lung cancer (NSCLC), according to a recent study published by Lanser et al in JNCCN–Journal of the National Comprehensive Cancer Network.


Alectinib has been shown to be a safe and effective treatment for patients with some types of advanced lung cancer.

“Alectinib is a standard-of-care oral small molecule inhibitor for patients with ALK-rearranged metastatic [NSCLC]. Maintaining therapeutic doses long term is key to this drug’s activity,” explained Sandip Patel, MD, Professor of Medicine at the University of California (UC), San Diego School of Medicine, a medical oncologist at Moores Cancer Center at UC San Diego Health, and a member of the NCCN Clinical Practice Guidelines in Oncology Panel for NSCLC, who was not involved in the study.

Study Methods and Results

In the recent study, the researchers randomly assigned 20 patients to receive one of two dose levels of alectinib daily with either low-fat yogurt alone, a full continental breakfast, or a lunch of their choosing. The researchers discovered that patients who took alectinib with low-fat yogurt experienced 14% and 20% less exposure to the drug compared with those who took the alectinib with the continental breakfast and with lunch, respectively. The relative differences in alectinib plasma concentrations were measured 12 hours after the last dose.

“This is important information for patients, since we know that higher alectinib concentrations in [the bloodstream] could result in more efficacy of the drug, a longer treatment duration, and therefore, hopefully, a better survival [outcome],” highlighted lead study author Daan A.C. Lanser, MSc, a PhD candidate in the Department of Medical Oncology at the Erasmus Cancer Institute at the Erasmus University Medical Center. “Sometimes, we hear that patients are advised to take their twice daily alectinib strictly 12 hours apart, with the result that some patients will take it with just a small snack in the morning or evening. We believe that taking it with a substantial meal containing enough fat is far more important for the absorption and efficacy of the treatment than to wait 12 hours between doses,” he emphasized.

The researchers noted that the number and severity of side effects were low overall and reported no significant statistical differences between the three groups.


“This important study highlights the key role of diet on the efficacy of oral cancer drugs. Medication-diet interactions are just as important as medication-medication interactions for oral cancer treatments,” underscored Dr. Patel. “In this study, the effect of taking a dose of alectinib with a small, low-fat snack resulted in more than a third of patients not reaching the goal alectinib drug concentration in blood—which highlights the need for education and dietary modification for patients taking these drugs long term,” he concluded.

Disclosure: For full disclosures of the study authors, visit

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