Case report: Drug-drug interaction between alectinib and apixaban in NSCLC

J. L. Gulikers; M. Slikkerveer; K. Winckers; L. E. L. Hendriks; S. Dursun; S. Croes; R. M. J. M. van Geel

doi:10.1016/j.cpccr.2022.100186

Case report: Drug-drug interaction between alectinib and apixaban in NSCLC

J. L. Gulikers, M. Slikkerveer, K. Winckers, L. E. L. Hendriks, S. Dursun, S. Croes, R. M. J. M. van Geel^*

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

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.

Original language	English
Article number	100186
Number of pages	3
Journal	Current Problems in Cancer: Case Reports
Volume	7
DOIs	https://doi.org/10.1016/j.cpccr.2022.100186
Publication status	Published - 1 Sept 2022

Keywords

Apixaban
Alectinib
DOAC
DDI

Access to Document

10.1016/j.cpccr.2022.100186Licence: CC BY

Cite this

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title = "Case report: Drug-drug interaction between alectinib and apixaban in NSCLC",

abstract = "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.",

keywords = "Apixaban, Alectinib, DOAC, DDI",

author = "Gulikers, {J. L.} and M. Slikkerveer and K. Winckers and Hendriks, {L. E. L.} and S. Dursun and S. Croes and {van Geel}, {R. M. J. M.}",

year = "2022",

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doi = "10.1016/j.cpccr.2022.100186",

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T1 - Case report

T2 - Drug-drug interaction between alectinib and apixaban in NSCLC

AU - Gulikers, J. L.

AU - Slikkerveer, M.

AU - Winckers, K.

AU - Hendriks, L. E. L.

AU - Dursun, S.

AU - Croes, S.

AU - van Geel, R. M. J. M.

PY - 2022/9/1

Y1 - 2022/9/1

N2 - 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.

AB - 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.

KW - Apixaban

KW - Alectinib

KW - DOAC

KW - DDI

U2 - 10.1016/j.cpccr.2022.100186

DO - 10.1016/j.cpccr.2022.100186

M3 - Article

SN - 2666-6219

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JO - Current Problems in Cancer: Case Reports

JF - Current Problems in Cancer: Case Reports

M1 - 100186

ER -