{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T15:23:52Z","timestamp":1791559432827,"version":"4.3.4"},"reference-count":4,"publisher":"BMJ","issue":"9","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2026,9,3]]},"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:p>Alectinib is a first-line tyrosine kinase inhibitor (TKI) for anaplastic lymphoma kinase (ALK)-rearranged non-small cell lung cancer (NSCLC) and is generally well tolerated. Severe renal toxicity is rare and evidence guiding management in elderly patients is limited. We describe a severe, reversible, dialysis-requiring nephrotoxicity confirmed by drug rechallenge, with successful subsequent treatment using an alternative ALK inhibitor.<\/jats:p>\n                  <jats:p>An elderly patient with advanced ALK-rearranged NSCLC developed kidney injury (AKI) shortly after initiation of alectinib, which progressed to dialysis-requiring renal failure. Renal function improved after treatment discontinuation but deteriorated again on alectinib rechallenge, strongly supporting drug-related causality. Urine sediment findings were consistent with acute tubular necrosis. Alectinib was permanently discontinued and treatment was switched to brigatinib, resulting in stable renal function and sustained oncological response.<\/jats:p>\n                  <jats:p>This case highlights that severe alectinib-induced nephrotoxicity, although rare, can occur and may be life-threatening, particularly in elderly patients with comorbidities and polypharmacy. Importantly, effective disease control can still be achieved through alternative ALK inhibitors.<\/jats:p>","DOI":"10.1136\/bcr-2026-276032","type":"journal-article","created":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T18:15:28Z","timestamp":1790100928000},"page":"e276032","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Severe, reversible alectinib-induced acute kidney injury requiring dialysis in an elderly patient with metastatic non-small cell lung cancer"],"prefix":"10.1136","volume":"19","author":[{"given":"Rita","family":"Rosa","sequence":"first","affiliation":[{"name":"Pulmonology Department, Instituto Portugu\u00eas de Oncologia de Lisboa Francisco Gentil EPE, Lisboa, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Telma","family":"Sequeira","sequence":"additional","affiliation":[{"name":"Pulmonology Department, Instituto Portugu\u00eas de Oncologia de Lisboa Francisco Gentil EPE, Lisboa, Portugal"},{"name":"Invited Genetics Professor, Faculdade de Medicina Universidade de Lisboa, Lisboa, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sofia","family":"L\u00e9rias","sequence":"additional","affiliation":[{"name":"Pathological Anatomy, Instituto Portugu\u00eas de Oncologia de Lisboa Francisco Gentil EPE, Lisbon, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dulce","family":"Carvalho","sequence":"additional","affiliation":[{"name":"Nephrology, Unidade Local de Sa\u00fade S\u00e3o Jos\u00e9, Lisbon, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jorge","family":"Dionisio","sequence":"additional","affiliation":[{"name":"Pulmonology Department, Instituto Portugu\u00eas de Oncologia de Lisboa Francisco Gentil EPE, Lisboa, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,9,22]]},"reference":[{"key":"2026092211151919000_19.9.e276032.1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1704795"},{"key":"2026092211151919000_19.9.e276032.2","unstructured":"Peters S , Camidge DR , Mok T , et al . Alectinib versus crizotinib in previously untreated ALK-positive advanced non-small cell lung cancer: final overall survival analysis of the phase III ALEX study. Ann Oncol 2025;S0923-7534. doi:10.1016\/j.annonc.2025.04788"},{"key":"2026092211151919000_19.9.e276032.3","doi-asserted-by":"crossref","first-page":"1369118","DOI":"10.3389\/fimmu.2024.1369118","article-title":"Nephrotoxicity of targeted therapy used to treat lung cancer","volume":"15","author":"Li","year":"2024","journal-title":"Front Immunol"},{"key":"2026092211151919000_19.9.e276032.4","doi-asserted-by":"crossref","first-page":"283","DOI":"10.1038\/s41581-025-01031-3","article-title":"The nephrotoxic effects of anti-cancer therapies: consensus report of the 34th Acute Disease Quality Initiative workgroup","volume":"22","author":"Renaghan","year":"2026","journal-title":"Nat Rev Nephrol"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2026-276032","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T18:15:29Z","timestamp":1790100929000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2026-276032"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9]]},"references-count":4,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2026,9,22]]},"published-print":{"date-parts":[[2026,9]]}},"alternative-id":["10.1136\/bcr-2026-276032"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2026-276032","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9]]}}}