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Arriola E, de Castro J, García-Campelo R, Bernárdez B, Bernabé R, Bruna J, Dómine M, Isla D, Juan-Vidal Ó, López-Fernández T, Nadal E, Rodríguez-Abreu D, Vares M, Asensio Ú, García LF, Felip E. Expert Consensus on the Management of Adverse Events of Lorlatinib in the Treatment of ALK+ Advanced Non-small Cell Lung Cancer. Clin Drug Investig 2024:10.1007/s40261-024-01379-7. [PMID: 39085682 DOI: 10.1007/s40261-024-01379-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/23/2024] [Indexed: 08/02/2024]
Abstract
The use of anaplastic lymphoma kinase (ALK) tyrosine kinase inhibitors (TKIs), such as lorlatinib, for the treatment of patients with ALK gene rearrangement (or ALK-positive) non-small cell lung cancer (NSCLC) has been shown to improve the overall survival and quality of life of these patients. However, lorlatinib is not exempt from potential adverse events. Adequate monitoring and management of these adverse events are critical for increasing patient adherence to lorlatinib, thereby maximizing the benefits of treatment and minimizing the risks associated with treatment discontinuation. Considering that the adverse events of lorlatinib can affect different organs and systems, the participation of a multidisciplinary team, including cardiologists, neurologists, internal medicine specialists, and oncology pharmacists, is needed. This article presents specific and pragmatic strategies for identifying and treating the most relevant adverse events associated with lorlatinib in patients with advanced ALK-positive NSCLC based on the clinical experience of a multidisciplinary panel of experts.
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Affiliation(s)
- Edurne Arriola
- Medical Oncology Department, Hospital del Mar, Center for Biomedical Network Research on Cancer (CIBERONC), Barcelona, Spain.
| | - Javier de Castro
- Medical Oncology Department, La Paz University Hospital, Hospital La Paz Health Research Institute (IdiPAZ), Center for Biomedical Network Research on Cancer (CIBERONC), Madrid, Spain
| | - Rosario García-Campelo
- Medical Oncology Department, A Coruña University Hospital, Biomedical Research Institute of A Coruña (INIBIC), A Coruña, Spain
| | - Beatriz Bernárdez
- Oncological Pharmacy Unit, Santiago de Compostela University Clinical Hospital, Health Research Institute of Santiago de Compostela (IDIS), University of Santiago de Compostela, A Coruña, Spain
| | - Reyes Bernabé
- Medical Oncology Department, Virgen del Rocío University Hospital, Biomedicine Institute of Sevilla (IBIS), University of Sevilla, Sevilla, Spain
| | - Jordi Bruna
- Neuro-Oncology Unit, Bellvitge University Hospital, Catalan Institute of Oncology, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Manuel Dómine
- Medical Oncology Department, Fundación Jiménez Díaz University Hospital, Fundación Jiménez Díaz Health Research Institute (IIS-FJD), Autonomous University of Madrid, Madrid, Spain
| | - Dolores Isla
- Medical Oncology Department, University Hospital Lozano Blesa, Health Research Institute of Aragon (IIS Aragón), Zaragoza, Spain
| | - Óscar Juan-Vidal
- Medical Oncology Department, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Teresa López-Fernández
- Cardiology Department, La Paz University Hospital, Hospital La Paz Health Research Institute (IdiPAZ), Madrid, Spain
| | - Ernest Nadal
- Medical Oncology Department, Catalan Institute of Oncology, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Delvys Rodríguez-Abreu
- Insular-Maternity and Pediatric University Hospital Complex of Gran Canaria, University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - María Vares
- Internal Medicine Department, A Coruña University Hospital, A Coruña, Spain
| | | | | | - Enriqueta Felip
- Medical Oncology Department, Vall d'Hebron University Hospital and Vall d'Hebron Institute of Oncology, Barcelona, Spain
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Liu G, Mazieres J, Stratmann J, Ou SHI, Mok T, Grizzard M, Goto Y, Felip E, Solomon BJ, Bauer TM. A pragmatic guide for management of adverse events associated with lorlatinib. Lung Cancer 2024; 191:107535. [PMID: 38554546 DOI: 10.1016/j.lungcan.2024.107535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 03/07/2024] [Accepted: 03/11/2024] [Indexed: 04/01/2024]
Abstract
Lorlatinib is a brain-penetrant, third-generation tyrosine kinase inhibitor (TKI) indicated for the treatment of anaplastic lymphoma kinase (ALK)-positive metastatic non-small cell lung cancer (NSCLC). In clinical trials, lorlatinib has shown durable efficacy and a manageable safety profile in treatment-naive patients and in those who have experienced progression while receiving first- and/or second-generation ALK TKIs. Lorlatinib has a distinct safety profile from other ALK TKIs, including hyperlipidemia and central nervous system effects. Clinical trial data showed that most adverse events (AEs) can be managed effectively or reversed with dose modifications (such as dose interruptions or reductions) or with concomitant medications without compromising clinical efficacy or quality of life for patients. A pragmatic approach to managing AEs related to lorlatinib is required. We present patient-focused recommendations for the evaluation and management of select AEs associated with lorlatinib developed by clinicians and nurses with extensive lorlatinib expertise in routine clinical practice. The recommendations follow the general framework of "prepare, monitor, manage, reassess" to streamline AE management and assist in practical, actionable, and personalized patient care.
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Affiliation(s)
- Geoffrey Liu
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.
| | - Julien Mazieres
- Thoracic Oncology Department, Toulouse University Hospital, Toulouse, France.
| | - Jan Stratmann
- Department of Medicine II, Hematology/Oncology, University Hospital Frankfurt, Frankfurt, and National Network Genomic Medicine Lung Cancer, Cologne, Germany.
| | - Sai-Hong Ignatius Ou
- Chao Comprehensive Cancer Center, University of California Irvine School of Medicine, Orange, CA, USA.
| | - Tony Mok
- State Key Laboratory of South China, Chinese University of Hong Kong, Hong Kong Special Administrative Region of China, China.
| | - Mary Grizzard
- Sarah Cannon Research Institute/Tennessee Oncology, Nashville, TN, USA.
| | - Yasushi Goto
- Department of Thoracic Oncology, National Cancer Center Hospital, Tokyo, Japan.
| | - Enriqueta Felip
- Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, Barcelona, Spain.
| | | | - Todd M Bauer
- Sarah Cannon Research Institute/Tennessee Oncology, Nashville, TN, USA.
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Figueiredo A, Rodrigues A, Gaspar C, Felizardo M. Diagnosis and Treatment of Advanced ALK Rearrangement-Positive Non-Small-Cell Lung Cancer in Portugal: Results of a National Questionnaire. Drugs Real World Outcomes 2023; 10:545-555. [PMID: 37787868 PMCID: PMC10730491 DOI: 10.1007/s40801-023-00393-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/27/2023] [Indexed: 10/04/2023] Open
Abstract
BACKGROUND Rearrangements in the anaplastic lymphoma kinase (ALK) gene define a molecular subgroup of non-small-cell lung carcinoma (NSCLC) that should be treated with ALK-targeting tyrosine kinase inhibitors (TKIs). OBJECTIVE This study aimed to portray the Portuguese reality about the diagnosis and treatment of stage IV ALK-positive NSCLC. METHODS Institutions that treat lung cancer in Portugal were invited to participate in an anonymous electronic questionnaire. A total of 22/35 geographically dispersed institutions responded. A descriptive statistical analysis of the results was performed. RESULTS Reflex molecular testing was done in 54.6% of the institutions. Next-generation sequencing (NGS) was the preferred diagnostic method (90.9%). Typically, physicians obtained molecular study results within 14-21 days. Alectinib was the most commonly used first-line treatment. For patients with brain metastases, 86.4% of the physicians preferred alectinib and 13.6% preferred first-line brigatinib. In the case of asymptomatic oligoprogression in the central nervous system, 85.7% of physicians performed local treatment and kept the patient on a TKI; if symptomatic, 66.7% gave local treatment and stayed with the TKI, while 28.6% gave local treatment and altered the TKI. For patients with symptomatic systemic progression, 47.6% and 38.1% of physicians prescribed lorlatinib after initial treatment with alectinib or brigatinib, respectively. After progression on lorlatinib, 42.9% of respondents chose chemotherapy and 57.1% requested detection of resistance mutations. CONCLUSIONS NGS is widely used for the molecular characterization of ALK-positive NSCLC in Portugal. The country has access to up-to-date therapy. Overall, national clinical practice follows international recommendations for the diagnosis and treatment of ALK-positive NSCLC.
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Affiliation(s)
- Ana Figueiredo
- Department of Pulmonology, Centro Hospitalar e Universitário de Coimbra, Praceta Professor Mota Pinto, 3004-561, Coimbra, Portugal.
| | - Ana Rodrigues
- Department of Medical Oncology, Instituto Português de Oncologia do Porto, Rua Dr. António Bernardino de Almeida, 4200-072, Porto, Portugal
| | - Carina Gaspar
- Medical & Scientific Management, Syneos Health, Avenida Duque d Ávilla, nº46, 3ºC, 1050-083, Lisboa, Portugal
| | - Margarida Felizardo
- Department of Pulmonology, Hospital Beatriz Ângelo, Av. Carlos Teixeira 3, 2674-514, Loures, Portugal
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Kilickap S, Ak S, Dursun OU, Sendur MA, Karadurmus N, Demirci U. Safety of lorlatinib in ALK-positive non-small-cell lung cancer and management of central nervous system adverse events. Future Oncol 2023; 19:2003-2012. [PMID: 37449387 DOI: 10.2217/fon-2023-0014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/18/2023] Open
Abstract
The use of tyrosine kinase inhibitors has made a breakthrough in the treatment of non-small-cell lung cancer (NSCLC). Recently, lorlatinib, a third-generation tyrosine kinase inhibitor, has demonstrated significant systemic and intracranial activity in both first-line and subsequent-line therapy in ALK-positive NSCLC patients. In this review, general characteristics of lorlatinib, its efficacy in the treatment of ALK-positive NSCLC patients and the safety of lorlatinib, particularly addressing central nervous system adverse events, are discussed. Management of central nervous system adverse events, which seem to be specific to lorlatinib therapy, is outlined.
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Affiliation(s)
- Saadettin Kilickap
- Liv Hospital Ankara, Medical Oncology Unit, Ankara, 06680, Turkey
- Department of Medical Oncology, Istinye University Faculty of Medicine, Istanbul, 34010, Turkey
| | - Sertac Ak
- Hacettepe University, Faculty of Medicine, Department of Psychiatry, Ankara, 06230, Turkey
| | | | - Mehmet An Sendur
- Department of Medical Oncology, Ankara Yıldırım Beyazit University, Faculty of Medicine, Ankara, 06800, Turkey
- Ankara City Hospital, Medical Oncology Clinic, Ankara, 06800, Turkey
| | - Nuri Karadurmus
- Saglik Bilimleri University, Gulhane Training & Research Hospital, Medical Oncology Department, Ankara, 06010, Turkey
| | - Umut Demirci
- Memorial Ankara Hospital, Medical Oncology Unit, Ankara, 06520, Turkey
- Department of Internal Diseases, Uskudar University Medical Faculty, Istanbul, 34768, Turkey
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[Chinese Expert Consensus on Management of Special Adverse Effects
Associated with Lorlatinib]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2022; 25:555-566. [PMID: 36002192 PMCID: PMC9411957 DOI: 10.3779/j.issn.1009-3419.2022.101.39] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Anaplastic lymphoma kinase (ALK) fusions represent the second most common oncogenic driver mutation in non-small cell lung cancer (NSCLC). As the new class of 3rd generation of ALK tyrosine kinase inhibitor (TKI), lorlatinib has shown robust potency and brain-penetrant clinical activity against a wide spectrum of multiple resistance mutations within the ALK domain detected during crizotinib and 2nd generation ALK TKI treatment. Lorlatinib is generally well-tolerated with unique adverse drug reaction/adverse event, including hyperlipidemia and central nervous system effects, which are mostly mild to moderate severity and manageable through dosage modifications and/or standard medical intervention. For advanced NSCLC with ALK positivity, patients should be evaluated for baseline characteristics and pre-existing medication, informed of the potential toxicities, and periodically monitored to balance benefits and risks. Moreover, a multidisciplinary group of experts is essential to establish a comprehensive diagnostic and therapeutic strategy.
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Baba K, Goto Y. Lorlatinib as a treatment for ALK-positive lung cancer. Future Oncol 2022; 18:2745-2766. [PMID: 35787143 DOI: 10.2217/fon-2022-0184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Lorlatinib, a third-generation ALK tyrosine kinase inhibitor, has been approved as a treatment for ALK-positive lung cancer. This review provides information regarding the pharmacology and clinical features of lorlatinib, including its efficacy and associated adverse events. Pivotal clinical trials are discussed along with the current status of lorlatinib as a treatment for ALK-positive lung cancer and future therapeutic challenges.
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Affiliation(s)
- Keisuke Baba
- Department of Thoracic Oncology, National Cancer Center Hospital, Chuo-ku, Tokyo, Japan
| | - Yasushi Goto
- Department of Thoracic Oncology, National Cancer Center Hospital, Chuo-ku, Tokyo, Japan
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Sisi M, Fusaroli M, De Giglio A, Facchinetti F, Ardizzoni A, Raschi E, Gelsomino F. Psychiatric Adverse Reactions to Anaplastic Lymphoma Kinase Inhibitors in Non-Small-Cell Lung Cancer: Analysis of Spontaneous Reports Submitted to the FDA Adverse Event Reporting System. Target Oncol 2022; 17:43-51. [PMID: 35025076 PMCID: PMC8783913 DOI: 10.1007/s11523-021-00865-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2021] [Indexed: 12/19/2022]
Abstract
Background The development of anaplastic lymphoma kinase (ALK) tyrosine kinase inhibitors (TKIs) has improved the survival outcomes of patients with advanced ALK-rearranged non-small-cell lung cancer (NSCLC). The adverse events (AEs) related to ALK inhibitors are fairly well known; notably, about 20% of patients receiving lorlatinib experienced cognitive effects and behavioral alterations in pivotal trials. Therefore, psychiatric disorders could represent AEs of special interest for all ALK TKIs, deserving careful assessment in the post-marketing setting. Objective We conducted a real-world pharmacovigilance study on psychiatric AEs with marketed ALK inhibitors in subjects with advanced NSCLC. Patients and methods We performed an observational, retrospective analysis of spontaneous reports submitted to the Food and Drug Administration Adverse Events Reporting System (FAERS, as of December 2020), selecting psychiatric AEs to ALK TKIs approved in NSCLC (crizotinib, ceritinib, alectinib, brigatinib, lorlatinib). These AEs were independently scrutinized by three oncologists applying predefined exclusion criteria, described in terms of clinical/demographic features and assessed for drug-related causality according to an adaptation of the WHO–UMC system, a standardized probabilistic algorithm. Results Among 584 reported psychiatric AEs, 95 cases were selected as potentially treatment related, with higher reporting frequency for lorlatinib (26, 2.8%), followed by brigatinib (10, 1.2%), alectinib (18, 0.7%), ceritinib (12, 0.6%), and crizotinib (29, 0.3%). Reported psychiatric symptoms were mood disorders (39), psychotic disorders (24), and anxiety, agitation, and irritability (25). In the majority (74%) of cases, psychiatric AEs were serious and required hospitalization in about 32% of patients; 15.8% of retained cases were considered as highly probable and 69.5% as probable. Drug discontinuation was recorded in 31.6% of the reported cases, with the highest proportion for lorlatinib (65.4%). Conclusion Notwithstanding limitations, our study found a higher proportion of psychiatric AEs with lorlatinib, but also raised the hypothesis of psychiatric reactions as a class effect of ALK TKIs. Supplementary Information The online version contains supplementary material available at 10.1007/s11523-021-00865-8.
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Affiliation(s)
- Monia Sisi
- Department of Experimental, Diagnostic and Specialty Medicine, Policlinico S. Orsola-Malpighi, Alma Mater Studiorum-University of Bologna, Bologna, Italy.
| | - Michele Fusaroli
- Pharmacology Unit, Department of Medical and Surgical Sciences, Alma Mater Studiorum-University of Bologna, Bologna, Italy
| | - Andrea De Giglio
- Department of Experimental, Diagnostic and Specialty Medicine, Policlinico S. Orsola-Malpighi, Alma Mater Studiorum-University of Bologna, Bologna, Italy.,Divisione di Oncologia Medica, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Francesco Facchinetti
- Institut Gustave Roussy, Inserm, Biomarqueurs Prédictifs et Nouvelles Stratégies Thérapeutiques en Oncologie, Université Paris-Saclay, Villejuif, France
| | - Andrea Ardizzoni
- Department of Experimental, Diagnostic and Specialty Medicine, Policlinico S. Orsola-Malpighi, Alma Mater Studiorum-University of Bologna, Bologna, Italy.,Divisione di Oncologia Medica, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Emanuel Raschi
- Pharmacology Unit, Department of Medical and Surgical Sciences, Alma Mater Studiorum-University of Bologna, Bologna, Italy
| | - Francesco Gelsomino
- Department of Experimental, Diagnostic and Specialty Medicine, Policlinico S. Orsola-Malpighi, Alma Mater Studiorum-University of Bologna, Bologna, Italy.,Divisione di Oncologia Medica, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
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