Lorlatinib After Alectinib-Induced Pneumonitis: A Case Report

James A Fletcher; William J Mullally; Rahul Ladwa; Kenneth J O'Byrne

doi:10.1016/j.jtocrr.2023.100591

Lorlatinib After Alectinib-Induced Pneumonitis: A Case Report

JTO Clin Res Rep. 2023 Oct 19;5(2):100591. doi: 10.1016/j.jtocrr.2023.100591. eCollection 2024 Feb.

Authors

James A Fletcher^{1

2}, William J Mullally¹, Rahul Ladwa^{1

2}, Kenneth J O'Byrne^{1

3}

Affiliations

¹ Division of Cancer Services, Princess Alexandra Hospital, Brisbane, Queensland, Australia.
² Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.
³ Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia.

Abstract

ALK gene rearrangements are detected in approximately 3% to 5% of NSCLC. ALK tyrosine kinase inhibitors, such as third-generation lorlatinib, have exhibited remarkable efficacy in ALK-rearranged NSCLC; however, they have been associated with a low incidence of treatment-limiting and potentially fatal drug-induced interstitial lung disease (ILD). There is concern that this may represent a class effect, a theory that is supported by a number of case reports. Because of clinical trial exclusion criteria, there are limited prospective data to guide decision-making after ALK tyrosine kinase inhibitors-induced ILD. A systematic review of the literature was conducted and only identified four reported cases of lorlatinib safety in this context. Here, we report the successful sequencing of lorlatinib in a patient who discontinued alectinib secondary to grade 3 drug-induced ILD.

Keywords: Alectinib; Case report; Lorlatinib; NSCLC; Pneumonitis.

Publication types

Case Reports