A recent study found a high rate of bradycardia among patients with non-small cell lung cancer (NSCLC) receiving alectinib treatment. These findings were published in JACC: CardioOncology.

In NSCLC, the subset of patients with translocations in the gene anaplastic lymphoma kinase (ALK) are candidates to receive tyrosine kinase inhibitor (TKI) treatments, such as alectinib. Alectinib is generally well-tolerated but can have toxicity outcomes with long-term use.

This prospective observational study was conducted using data collected at the Erasmus Medical Centre Cancer Institute in the Netherlands between 2020 and 2021. Fifty-three patients with ALK-positive NSCLC who received alectinib underwent cardiac evaluations at baseline and after alectinib use.

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Patients in this study were median age 63 years (range, 21 to 82), 59% were women, 68% had never smoked, and 14% had more than 1 cardiovascular risk factor at baseline.

With alectinib use, heart rate significantly reduced at all time points compared with baseline (all P <.001). Excluding baseline, heart rate stayed consistent after starting alectinib (all P >.50).

During a median follow-up of 21 months, 42% developed bradycardia, 30% developed myalgia, and 13% developed edema.

The median time to bradycardia was 3 weeks, with 91% developing bradycardia within 3 months.

Bradycardia events led to dose reductions in 9 patients, and the dose reduction did not improve symptoms in 5 patients with 3 requiring another dose reduction. A pacemaker was implanted in 1 patient.

The incidence of bradycardia was not related to prior TKI treatment, b-blocker use, or cardiovascular risk factors (all P ≥.69).

These data may have been limited as diastolic function was not systematically evaluated.

The study authors concluded that cardiologists should be involved in care for patients with cancer receiving novel anticancer drugs. Additional study is needed to better understand the relationship between bradycardia and alectinib.

Disclosure: Some authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.


Pruis MA, Veerman GDM, Hassing HC, et al. Cardiac toxicity of alectinib in patients with ALK+ lung cancer: outcomes of cardio-oncology follow-up. JACC CardioOncol. 2023;5(1):102-113. doi:10.1016/j.jaccao.2022.09.006