[Metabolic and cardiovascular disorders with lorlatinib: How to detect and manage them in practice?]

Therapeutic advances have led to an increase in the number of patients living with cancer, requiring heightened vigilance for cardiovascular complications. This article discusses the monitoring and management of cardiovascular adverse events in cancer patients, particularly those receiving lorlatinib, a third-generation tyrosine kinase inhibitor used in the treatment of advanced non-small cell lung cancer with ALK gene rearrangement. Antitumor treatments such as lorlatinib can cause cardiac and metabolic complications, which has led to the development of cardio-oncology as a specialized discipline. The 5-year data from the CROWN phase III study confirms the efficacy of lorlatinib, but also show the occurrence of significant adverse events, including dyslipidemia (hypercholesterolemia/hypertriglyceridemia), weight gain and hypertension. A multidisciplinary group of experts has therefore drawn up practical proposals for the management of metabolic and cardiovascular side effects associated with lorlatinib. The article addresses the management of dyslipidemia, hypertension, conduction disorders and QT interval prolongation induced by lorlatinib. Finally, nutritional management is discussed, as is the role of adapted physical activity. In conclusion, this article highlights the importance of proactive monitoring and management of adverse cardiovascular events in patients treated with lorlatinib.