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Lorlatinib experience in a patient with ALK + non-small cell lung cancer on hemodialysis: A case report
Ali Fuat Gürbüz1, Melek Karakurt Eryılmaz1, Oğuzhan Yıldız1
1Department of Medical Oncology, Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey.
Introduction:
Lorlatinib is a potent third-generation anaplastic lymphoma kinase/c-ros oncogene 1 (ALK)/ROS1 oral tyrosine kinase inhibitor that has broad coverage of acquired resistance mutations and is currently indicated for the treatment of adult patients with metastatic non-small cell lung cancer (NSCLC) whose tumors are ALK-positive.
Case Report:
In this case, we aimed to present the safety and effectiveness of lorlatinib use in a patient diagnosed with ALK-positive metastatic NSCLC who underwent hemodialysis 3 days a week.
Management & Outcome:
A 76-year-old female patient has been undergoing regular hemodialysis for about 2 years. A brain magnetic resonance imaging (MRI) was taken due to headache and a mass was detected. She was diagnosed with lung adenocarcinoma as a result of excisional biopsy. Positron emission tomography/ computed tomography (PET/CT) showed a mass in the hilar region of the left lung and multiple lymphadenopathy in the mediastinum. In February 2023, 100 mg lorlatinib was started daily. There was no significant regression in PET-CT and no brain MRI residue during follow-up. The patient has been continuing lorlatinib for approximately 1 year with almost complete response, with no side effects other than hypercholesterolemia.
Discussion:
We presented our experience using lorlatinib in a patient with metastatic ALK + NSCLC undergoing hemodialysis. Although the dosage of lorlatinib in hemodialysis patients is still controversial, our case report indicates that 100 mg lorlatinib was safe in this patient.
Insights
Lorlatinib, an anaplastic lymphoma kinase (ALK) inhibitor, showed safety and effectiveness in a metastatic non-small cell lung cancer (NSCLC) patient undergoing hemodialysis. This case suggests 100 mg daily lorlatinib is a viable option for ALK-positive NSCLC patients on dialysis.
Area of Science:
- Oncology
- Pharmacology
- Nephrology
Background:
- Lorlatinib is a third-generation ALK/ROS1 inhibitor for ALK-positive metastatic non-small cell lung cancer (NSCLC).
- Its use in patients undergoing hemodialysis requires careful consideration due to potential drug accumulation.
Purpose of the Study:
- To evaluate the safety and effectiveness of lorlatinib in an ALK-positive metastatic NSCLC patient on hemodialysis.
- To assess the tolerability of a 100 mg daily dose of lorlatinib in this specific patient population.
Main Methods:
- Case report of a 76-year-old female with ALK-positive metastatic NSCLC undergoing hemodialysis.
- Initiation of 100 mg daily lorlatinib treatment.
- Monitoring via PET/CT and brain MRI, with assessment for side effects.
Main Results:
- The patient achieved an almost complete response after approximately 1 year of treatment.
- No significant regression was noted on PET-CT, but no brain MRI residue was observed.
- The only reported side effect was hypercholesterolemia, indicating good tolerability.
Conclusions:
- Lorlatinib at 100 mg daily was safe and effective in this patient with ALK-positive metastatic NSCLC undergoing hemodialysis.
- This case suggests that lorlatinib may be a feasible treatment option for similar patients, despite ongoing dosage controversies.
