[Chinese Expert Consensus on Management of Special Adverse Effects Associated with Lorlatinib]

Zhongguo Fei Ai Za Zhi. 2022 Aug 20;25(8):555-566. doi: 10.3779/j.issn.1009-3419.2022.101.39.
[Article in Chinese]

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. .

【中文题目:洛拉替尼特殊不良反应管理中国专家共识】 【中文摘要:间变性淋巴瘤激酶(anaplastic lymphoma kinase, ALK)融合基因是非小细胞肺癌(non-small cell lung cancer, NSCLC)中第二常见的肿瘤驱动基因。作为新型的第三代ALK酪氨酸激酶抑制剂(tyrosine kinase inhibitor, TKI),洛拉替尼对多种ALK激酶域突变具有广谱且高效的临床活性,并具有强大的穿透血脑屏障效力。洛拉替尼的总体耐受性良好,其独特的不良反应或不良事件包括高脂血症与中枢神经系统反应等,多为轻至中度,通常经剂量调整和/或标准医疗干预即可管理。对于ALK阳性晚期NSCLC,开始洛拉替尼治疗前应充分评估患者基线特征与既往用药状况,预先告知患者可能经历的用药相关不良反应,并定期监测以实现药物临床获益的最大化。同时,多学科专家团队对于建立全面的诊断和治疗策略是至关重要的。 】 【中文关键词:间变性淋巴瘤激酶;肺肿瘤;洛拉替尼;不良反应】.

Keywords: Adverse event; Anaplastic lymphoma kinase; Lorlatinib; Lung neoplasms.

MeSH terms

  • Aminopyridines
  • Carcinoma, Non-Small-Cell Lung* / drug therapy
  • Carcinoma, Non-Small-Cell Lung* / genetics
  • Carcinoma, Non-Small-Cell Lung* / pathology
  • China
  • Consensus
  • Drug Resistance, Neoplasm / genetics
  • Drug-Related Side Effects and Adverse Reactions* / drug therapy
  • Humans
  • Lactams
  • Lactams, Macrocyclic / adverse effects
  • Lung Neoplasms* / drug therapy
  • Lung Neoplasms* / genetics
  • Lung Neoplasms* / pathology
  • Protein Kinase Inhibitors / adverse effects
  • Protein-Tyrosine Kinases / genetics
  • Pyrazoles

Substances

  • Aminopyridines
  • Lactams
  • Lactams, Macrocyclic
  • Protein Kinase Inhibitors
  • Pyrazoles
  • Protein-Tyrosine Kinases
  • lorlatinib