Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.
Thoracic Oncology Department, Toulouse University Hospital, Toulouse, France.
Lung Cancer. 2024 May;191:107535. doi: 10.1016/j.lungcan.2024.107535. Epub 2024 Mar 15.
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.
洛拉替尼是一种可穿透血脑屏障的第三代酪氨酸激酶抑制剂（TKI），用于治疗间变性淋巴瘤激酶（ALK）阳性转移性非小细胞肺癌（NSCLC）。在临床试验中，洛拉替尼在未经治疗的患者和接受第一代和/或第二代 ALK TKI 治疗后进展的患者中均显示出持久的疗效和可管理的安全性。洛拉替尼与其他 ALK TKI 的安全性特征不同，包括血脂异常和中枢神经系统效应。临床试验数据表明，大多数不良反应（AE）可以通过剂量调整（如剂量中断或减少）或联合用药有效管理或逆转，而不会影响患者的临床疗效或生活质量。需要采取务实的方法来管理与洛拉替尼相关的 AE。我们提出了由在常规临床实践中具有丰富洛拉替尼专业知识的临床医生和护士制定的针对与洛拉替尼相关的特定 AE 的以患者为中心的评估和管理建议。这些建议遵循“准备、监测、管理、重新评估”的总体框架，以简化 AE 管理并协助提供实用、可操作和个性化的患者护理。
