Lorlatinib After Alectinib-Induced Pneumonitis: A Case Report

James A. Fletcher M.B.B.S. , William J. Mullally MBBCh BAO , Rahul Ladwa MPhil , Kenneth J. O’Byrne MD
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Abstract

ALK gene rearrangements are detected in approximately 3% to 5% of NSCLC. ALK tyrosine kinase inhibitors, such as third-generation lorlatinib, have exhibited remarkable efficacy in ALK-rearranged NSCLC; however, they have been associated with a low incidence of treatment-limiting and potentially fatal drug-induced interstitial lung disease (ILD). There is concern that this may represent a class effect, a theory that is supported by a number of case reports. Because of clinical trial exclusion criteria, there are limited prospective data to guide decision-making after ALK tyrosine kinase inhibitors–induced ILD. A systematic review of the literature was conducted and only identified four reported cases of lorlatinib safety in this context. Here, we report the successful sequencing of lorlatinib in a patient who discontinued alectinib secondary to grade 3 drug-induced ILD.

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阿来替尼诱发肺炎后的罗拉替尼:病例报告
在大约3%至5%的NSCLC中可检测到ALK基因重排。ALK酪氨酸激酶抑制剂(如第三代劳拉替尼等)对ALK基因重排的NSCLC有显著疗效;但它们与治疗限制性和潜在致命的药物诱发间质性肺病(ILD)的低发生率有关。有人担心这可能是一种类药物效应,一些病例报告也支持这一理论。由于临床试验的排除标准,目前用于指导 ALK 酪氨酸激酶抑制剂诱发 ILD 后决策的前瞻性数据非常有限。我们对文献进行了系统性回顾,结果只发现了四例有关lorlatinib在这种情况下安全性的报道。在此,我们报告了一位因3级药物诱导的ILD而停用阿来替尼的患者成功进行了lorlatinib排序。
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来源期刊
CiteScore
4.20
自引率
0.00%
发文量
145
审稿时长
19 weeks
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