Lorlatinib After Alectinib-Induced Pneumonitis: A Case Report
James A Fletcher1,2, William J Mullally1, Rahul Ladwa1,2
1Division of Cancer Services, Princess Alexandra Hospital, Brisbane, Queensland, Australia.
JTO Clinical and Research Reports
|February 15, 2024
Summary
Anaplastic lymphoma kinase (ALK) tyrosine kinase inhibitors can cause interstitial lung disease (ILD). This case study details successful lorlatinib sequencing in an ALK-rearranged NSCLC patient with prior alectinib-induced ILD.
Area of Science:
- Oncology
- Pulmonology
- Pharmacology
Background:
- Anaplastic lymphoma kinase (ALK) gene rearrangements occur in 3-5% of non-small cell lung cancer (NSCLC).
- ALK tyrosine kinase inhibitors (TKIs) are effective for ALK-rearranged NSCLC but can cause drug-induced interstitial lung disease (ILD).
- Limited prospective data exist for managing ILD following ALK TKI treatment due to clinical trial exclusion criteria.
Observation:
- A systematic literature review identified only four reported cases of lorlatinib safety in patients with prior ALK TKI-induced ILD.
- This report details a case of a patient with ALK-rearranged NSCLC who discontinued alectinib due to grade 3 drug-induced ILD.
Findings:
- Successful sequencing of lorlatinib was achieved in a patient with a history of grade 3 alectinib-induced ILD.
- This demonstrates a potential treatment option for ALK-rearranged NSCLC patients who have experienced severe ILD with other ALK TKIs.
Implications:
- This case provides valuable clinical insight into managing ALK-rearranged NSCLC in patients with a history of TKI-induced ILD.
- Further research is warranted to establish the safety and efficacy of lorlatinib in this specific patient population.
- This finding may inform clinical decision-making and treatment strategies for patients with complex ILD histories on ALK inhibitors.
