Successful Introduction of Lorlatinib After Drug Eruption With Alectinib in ALK-Positive Lung Adenocarcinoma: A Case...

Anaplastic lymphoma kinase (ALK) fusion genes are detected in approximately 3%-5% of non-small cell lung cancers (NSCLC). Alectinib and lorlatinib are ALK tyrosine kinase inhibitors with established efficacy; however, their adverse event profiles differ. We report a 61-year-old man with recurrent ALK-positive lung adenocarcinoma who developed a grade 2 drug eruption consistent with fixed drug eruption during alectinib therapy. The rash resolved following drug discontinuation and corticosteroid treatment. Lorlatinib was subsequently initiated without recurrence of cutaneous toxicity. Apart from Common Terminology Criteria for Adverse Events (CTCAE) Grade 2 dyslipidemia, no significant adverse events occurred, and partial response has been maintained for over 1 year. This case suggests that lorlatinib may be a feasible alternative in patients who develop cutaneous adverse reactions to alectinib, enabling continuation of targeted therapy.