Medical Oncologist
Drug monitoring
Tests and Monitoring — While You Are on Alectinib
Your team schedules specific blood tests and scans while you are on alectinib because the drug can affect your liver, muscles and heart rate as well as the cancer. Knowing which tests are coming and what they check helps you understand each visit.
Medically reviewed by Dr. C. Raghavendra Reddy, Medical Oncologist, MBBS (Gold Medal) · DNB · DM (Medical Oncology, Gold Medal) · Last reviewed August 2026
- Liver and muscle tests come first — The drug can affect liver enzymes and a muscle enzyme called CPK, so these are checked most often in the first months.
- Scans confirm whether it is working — CT or PET-CT scans at regular intervals show whether the tumour is responding to treatment.
- Most monitoring is a blood draw — The majority of checks are simple blood tests done at your day-care visit — no hospital admission is needed.
- Symptoms between appointments matter — New muscle pain, breathlessness or a noticeably slow heartbeat should be reported before your next scheduled visit.
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While you are on alectinib, your team monitors liver enzymes, a muscle enzyme called CPK, blood counts, kidney function and heart rate, alongside regular scans. Monitoring is most intensive in the first months. Most people complete checks as day care without being admitted.
Which tests will I have, and what does each one check?
| Test | What it checks | Typical schedule | What warrants a call or review |
|---|---|---|---|
| Liver enzymes (ALT, AST, bilirubin) | Whether the drug is putting stress on the liver | Every few weeks in the first months, then less often once stable | Any sharp or persistent rise — your team will track your trend and act on it |
| CPK (creatine kinase) | A muscle enzyme that rises when muscles are affected | Monthly, especially in the first year | A significant rise alongside muscle pain, weakness or dark-coloured urine — call that day |
| Full blood count | Haemoglobin, white cells and platelets | Periodically throughout treatment | Falling haemoglobin causing new breathlessness or fatigue; white cells low enough to raise infection risk |
| Kidney function (creatinine) | How well the kidneys are filtering | Periodically | A consistent upward trend compared to your own baseline |
| Heart rate | Alectinib can slow the heart in some people | At every clinic visit, and any time you feel faint or dizzy | A pulse consistently below your usual, especially with symptoms — contact your team |
| CT or PET-CT scan | Whether the tumour is shrinking, stable or changing | Earlier in treatment, then roughly every few months | New lesions, a change in size, or new symptoms between scans |
| Lung symptom check | Early signs of interstitial lung disease — rare but serious | Your team asks directly at every visit | Any new dry cough, breathlessness or fever — call the same day, do not wait |
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Medical Oncologist
Dr. C. Raghavendra Reddy
MBBS(Gold Medal), DNB(General Medicine), DM(Medical Oncology)(Gold Medal)
Medical Oncologist
Dr. Bharati Devi Gorantla
MBBS, MD(General Medicine), DM(Medical Oncology)(Adyar,Chennai), ECMO, MRCP SCE(UK)
Medical Oncologist
Dr. Owais Mohammed
MBBS, MD (General Medicine), DrNB (Medical Oncology), ECMO, MRCP SCE (Medical Oncology) (UK)
Medical Oncologist
Medical Oncologist
Surgical Oncologist
Dr. Muralidhar Muddusetty
MBBS (AIIMS), MS (Surgery) (AIIMS), DNB (Surgical Oncology), MRCS (Edinburgh)
Surgical Oncologist
Surgical Oncologist
Surgical Oncologist
Dr. Vinay Mamidala
MBBS, MS(General Surgery), M.Ch(Surgical Oncology), FMAS, FARIS(Ongoing)
Surgical Oncologist
Radiation Oncologist
Radiation Oncologist
Radiation Oncologist
Hematologist
Interventional Radiologist
Dr. Mohammed Imran
Surgical Oncologist
Dr. Vajja Sandeep Kumar
MBBS, MS (General Surgery), DrNB (Surgical Oncology), FALS Oncology
Surgical Oncologist
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How does monitoring work from the day you start?
Before your first dose
Your team takes baseline blood tests — liver enzymes, CPK, kidney function and full blood count — so they have your personal normal values to compare against later. Your heart rate is also recorded at this visit.
First two months
This is the most intensive monitoring period. Liver enzyme checks happen every few weeks because the drug is most likely to affect the liver early on. CPK and blood counts are checked at the same time.
Months three to twelve
Once your results are stable, liver checks become less frequent. CPK continues monthly through the first year. Your first scan to assess tumour response usually falls within this period.
Beyond the first year
Scans continue at regular intervals. Blood tests move to a schedule your oncologist sets based on how stable your results have been. Many people are seen roughly every three months at this stage.
If a result needs attention
Your team may hold your dose briefly or ask you to come in sooner. A result being flagged is not the same as treatment failing — it means the monitoring is working as it should.
What should I track at home between visits?
- Check your pulse at rest once a week and note it — report a consistently slow or irregular beat to your team.
- Tell your team immediately if you notice muscle pain, weakness or unusually dark-coloured urine.
- Report any new dry cough, breathlessness or fever the same day — do not wait for your next appointment.
- Bring a list of all supplements, vitamins and traditional medicines to every visit — some interact with alectinib.
- Note any missed or delayed doses and mention them at your visit, as this helps your team read your blood results accurately.
- Write down new symptoms with the date they started — patterns are easier to act on than vague recall.
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Common questions
Frequently asked questions
Do I need blood tests at every single visit?
Most visits include a blood draw, at least in the first year. The frequency reduces once your results have been stable for several months. Your oncologist sets the schedule based on your own trend — some people need more frequent checks because of early fluctuations in liver or muscle results. Never skip a scheduled blood test without asking your team first, as the results directly guide dose decisions.
What happens if my liver test comes back high?
A mildly elevated result is usually monitored more closely but does not automatically mean stopping treatment. If the rise is significant, your team may hold the dose while the liver recovers, then restart at the same or a lower dose. Most liver reactions on alectinib are reversible with dose management. Your team will tell you what category your result falls into and what the next step is.
Why does alectinib affect the liver and muscles?
Alectinib targets the ALK protein that drives the cancer, but the same molecular pathway is active in liver cells and muscle tissue. This is why the drug can raise liver enzymes and CPK even in people who feel completely well. Monitoring is there to catch these rises before they cause symptoms — which is why blood tests matter even when you feel fine.
What is bradycardia and should I be worried?
Bradycardia means a slower than usual heart rate. Alectinib can cause this in some people, and your team checks your pulse at every visit for that reason. Most cases are mild and cause no symptoms. If you feel faint, dizzy or short of breath, or if your pulse feels noticeably slower than usual, contact your team the same day rather than waiting. A resting pulse consistently below your personal normal is worth reporting even without symptoms.
Can I have my blood tests done closer to home?
Yes, in many cases. Your oncologist can arrange for routine blood tests — liver enzymes, CPK, blood count — to be done at a laboratory near you, with results reviewed by your CION team before your next visit. Scans such as CT or PET-CT are coordinated with partner imaging centres. Discuss this with your team and they will tell you which checks need to be done at the clinic and which can be done locally.