Drug Action
Lorlatinib is a tyrosine kinase inhibitor.
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Drug reference
Lorlatinib is a tyrosine kinase inhibitor.
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Anaplastic lymphoma kinase (ALK)-positive advanced non-small cell lung cancer (specialist use only) ▶BY MOUTH ▶Adult: 100 mg daily, for dose adjustments due to side- effects—consult product literature
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DUE TO INTERACTIONS ▶Manufacturer advises if concomitant use with potent CYP3A4 inhibitors is unavoidable, reduce starting dose to 75 mg once daily.
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Cardiac risk factors or conditions which may affect left ventricular ejection fraction—consider cardiac monitoring, including assessment of left ventricular ejection fraction, at baseline and during treatment. lactose intolerance. worsening respiratory symptoms indicative of interstitial lung disease or pneumonitis (including dyspnoea, cough, and fever)—withhold or permanently discontinue treatment based on severity
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Scottish Medicines Consortium (SMC) decisions SMC No. SMC2239 The Scottish Medicines Consortium has advised (March 2020) that lorlatinib (Lorviqua ®) is accepted for use within NHS Scotland on an interim basis subject to ongoing evaluation and future reassessment. It is used as monotherapy for the treatment of adults with anaplastic lymphoma kinase (ALK)-positive advanced non-small cell lung cancer whose disease has progressed after: . alectinib or ceritinib as the first ALK tyrosine kinase inhibitor therapy, or . crizotinib and at least one other ALK tyrosine kinase inhibitor. This advice is contingent upon the continuing availability of the patient access scheme in NHS Scotland or a list price that is equivalent or lower.
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RISKS OF INCORRECT DOSING OF ORAL ANTI-CANCER MEDICINES See Cytotoxic drugs p. 938.
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→Appendix 1: lorlatinib
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▶Common or very common Anaemia. anxiety. arthralgia. asthenia. behaviour abnormal. cognitive disorder. concentration impaired. confusion. constipation. delirium. dementia. depression. diarrhoea. dyslipidaemia . gait abnormal. hallucinations. headache. inflammation. learning disability. memory loss. mental impairment (thought disturbance). mood altered. muscle weakness. myalgia. nausea. nerve disorders. neurotoxicity. oedema . pain. peroneal nerve palsy. respiratory disorders. sensation abnormal. skin reactions. speech impairment. vision disorders. vitreous floater. weight increased ▶Frequency not known Atrioventricular block
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Manufacturer advises females of childbearing potential should use effective non- hormonal contraception during treatment and for 35 days after last treatment; male patients should use effective contraception during treatment and for 14 weeks after last treatment if their partner is pregnant or of childbearing potential. See also Pregnancy and reproductive function in Cytotoxic drugs p. 938.
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Manufacturer advises avoid—toxicity in animal studies. See also Pregnancy and reproductive function in Cytotoxic drugs p. 938.
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Manufacturer advises avoid during treatment and for 7 days after last treatment—no information available.
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Manufacturer advises avoid in moderate to severe impairment (no information available).
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Manufacturer advises avoid in severe impairment (limited information available).
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▶Manufacturer advises monitor serum cholesterol and triglycerides before starting treatment, then at weeks 2, 4, and 8, and regularly thereafter. ▶Manufacturer advises monitor ECG before starting treatment and monthly thereafter, particularly in patients with predisposing conditions. ▶Manufacturer advises monitor for lipase and amylase elevations before starting treatment, and regularly thereafter as clinically indicated.
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There can be variation in the licensing of different medicines containing the same drug. Tablet CAUTIONARY AND ADVISORY LABELS 25 A ▶Lorviqua (Pfizer Ltd) Lorlatinib 25 mg Lorviqua 25mg tablets | 120 tablet P £7,044.00 (Hospital only) Lorlatinib 100 mg Lorviqua 100mg tablets | 30 tablet P £5,283.00
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Missed doses Manufacturer advises if a dose is more than 20 hours late, the missed dose should not be taken and the next dose should be taken at the normal time. Driving and skilled tasks Manufacturer advises patients and carers should be counselled on the effects on driving and performance of skilled tasks—increased risk of CNS effects.
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100 mg daily, for dose adjustments due to side-
First-line fragment. Read the complete Indications and Dose section above.
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