Lorlatinib (LOBRENA)

Non-small cell lung cancer ((ALK)-positive), advanced or metastatic

Non-small cell lung cancer ((ALK)-positive), advanced or metastatic

• Oral: 100 mg once daily continuously until disease progression or unacceptable toxicity

Available as 25mg and 100 mg tablets. Tablets contain lactose. Tablets should NOT be crushed or broken. Store at room temperature and protect from light.

Multi-targeted TKI (tyrosine kinase inhibitor) which includes action as a Anaplastic Lymphoma Kinase(ALK) Inhibitor and a ROS-1 inhibitor

Take with or without food

If a dose is missed, patients should be instructed to take it as soon as they can if there are > 4 hours until the next dose. If there are < 4 hours until the next dose, patients should skip the missed dose and resume with the next scheduled dose.

Common: Hypercholesterolemia, Hypertriglyceridemia, Hyperlipidemia, Edema, Thrombocytopenia, Weight gain, Peripheral neuropathy, Cognitive disturbance, Mood disorder, Diarrhea, Cough, Dyspnea, Fatigue, Anemia, Amylase increase, Glucose increase, Lipase increase.

Less Common: Hypertension, Speech disturbance, PR interval prolongation, AV Block, Neurologic or psychiatric effects, Interstitial lung disease/pneumonitis.

The adverse effects listed above are not exhaustive. Please refer to the relevant product monograph for full details.

Baseline before treatment: ECG, blood pressure, cholesterol, triglycerides, lipase, amylase, glucose, liver function tests, CBC & differential, CNS toxicity assessment.

During treatment: ECG, blood pressure, cholesterol, triglycerides, CBC & differential, CNS toxicity assessment.

If clinically indicated: Lipase, amylase, glucose, liver function tests.

• May increase the risk for QT interval prolongation. Avoid concurrent therapy with drugs associated with QTc prolongation and/or Torsades de pointes, if possible. If unavoidable, monitor for QT prolongation or cardiac arrhythmias.
• Avoid grapefruit, grapefruit juice, Seville oranges, or Seville orange juice.
• This drug can impact or be impacted by metabolic enzymes for absorption and excretion. Many drugs can also affect or be affected by these enzymes, so please consult with pharmacy to assess for interactions.
• Current drug interaction databases should be consulted for more information.

• Avoid in pregnancy and lactation.
• Hypertension is common. Monitor blood pressure closely and manage with antihypertensives and dose hold/reductions. Hypertension should be well controlled prior to starting lorlatinib.
• CNS adverse effects can occur with lorlatinib. Patients should be assessed at each visit for CNS changes (examples include seizures, psychotic effects/changes and cognitive function, mood, speech, mental status, and sleep changes).

BC Cancer. BC Cancer Drug Manual. Lorlatinib. Vancouver, British Columbia: BC Cancer Agency. Available at: http://www.bccancer.bc.ca/drug-database-site/Drug%20Index/Lorlatinib_monograph.pdf. Updated December 1, 2023. Accessed January 22, 2024.

Lexicomp. Lorlatinib Monograph. In: Lexi-Drugs. Hudson, Ohio: Lexi-Comp, Inc. Available at: https://online-lexi-com.qe2a-proxy.mun.ca/lco/action/doc/retrieve/docid/patch_f/6724450?cesid=5uWnG3TBfwv&searchUrl=%2Flco%2Faction%2Fsearch%3Fq%3Dlorlatinib%26t%3Dname%26acs%3Dfalse%26acq%3Dlorlatinib. Updated January 24, 2024. Accessed January 28, 2024.

Cancer Care Ontario. Lorlatinib Monograph. Drug Formulary. Toronto, Ontario: Cancer Care Ontario. Available at: https://www.cancercareontario.ca/en/drugformulary/drugs/monograph/66571 . Updated August  2023. Accessed January 22, 2024.

Pfizer Canada. LORBRENA® product information. Kirkland, Quebec; Updated May 16, 2022