Alectinib (Alecensa) — A Complete Patient Guide

No. Alectinib is a capsule you take at home, twice daily with food. You do not need a hospital drip or a day-care infusion. You will still need regular clinic visits for blood tests and check-ups, and scans to assess your response — but the medication itself is taken at home on your own schedule. Your team will explain how often they want to see you when you start treatment.

Yes, and this is one of the reasons alectinib is preferred over earlier ALK inhibitors in guidelines from NCCN and ESMO. It is designed to cross the blood-brain barrier. For people with brain metastases at the time of starting, alectinib can address both the lung disease and the brain involvement together, though the approach depends on how many lesions there are and where they are situated. Your oncologist will explain what this means for your specific imaging results.

Alectinib is taken for as long as it continues to control the cancer and you can tolerate it. It is not a fixed course in the way some chemotherapy regimens are. Response is assessed by regular scans, and the treatment plan is reviewed at each assessment. Some people take it for several years. The question of what happens if it ever stops working is a separate conversation — your oncologist will have it with you when it becomes relevant, not as something to plan around at the start.

Call the same day for new breathlessness or a cough that is not going away — this can indicate lung inflammation, which needs prompt assessment. Also call the same day for yellowing of the eyes or skin, a very slow or irregular heartbeat, dizziness on standing, or severe muscle weakness or pain that is stopping you from moving normally. When you are unsure whether something needs a call, call. Your team would rather reassure you than have you wait with something that needs treatment.

Take alectinib with food — a full meal or a substantial snack each time — which helps with both absorption and tolerability. Your pharmacist or oncologist will advise you specifically about grapefruit and grapefruit juice, which can interact with many targeted therapies; as a general rule it is safer to avoid them unless told otherwise. Also tell your team about any herbal medicines, supplements, or traditional remedies you are taking, including things bought without a prescription. Some can affect how the drug is processed by the body.

If alectinib stops controlling the cancer — what oncologists call acquired resistance — your team will assess what has changed in the tumour, often with a repeat biopsy or liquid biopsy. Depending on what that testing shows, there may be another targeted therapy suited to the new mutation pattern. This is an area where evidence is still developing, and the best next step is not the same for everyone. A change in the tumour at that point does not mean you have run out of options — it means a fresh test is needed to identify the next one.