Lorlatinib, sold under the brand name Lorbrena in the United States, Canada, and Japan, and Lorviqua in the European Union, is an anti-cancer drug developed by Pfizer. It is an orally administered inhibitor of ALK and ROS1, two enzymes that play a role in the development of cancer. Medical uses
Lorlatinib is approved in the US and in Europe for the second- or third-line treatment of ALK-positive metastatic non-small-cell lung cancer (NSCLC). It is the only ALK inhibitor with meaningful activity against ALK G1202R mutation in lung cancer. Contraindications
Lorlatinib must not be combined with strong inducers (i.e. activators) of the liver enzymes CYP3A4/5 if it can be avoided, as serious cases of liver toxicity have been observed under combination with the CYP3A4/5 inducer rifampicin. Side effects
The most common side effects in studies were high blood cholesterol (84% of patients), high blood triglycerides (67%), edema (55%), peripheral neuropathy (48%), cognitive effects (29%), fatigue (28%), weight gain (26%), and mood effects (23%). Serious side effects led to dose reduction in 23% of patients and in termination of lorlatinib treatment in 3% of patients. Interactions
Lorlatinib is metabolized by the enzymes CYP3A4/5. Therefore, CYP3A4/5 inducers such as rifampicin, carbamazepine or St Johns wort decrease its concentrations in the blood plasma and can reduce its effectiveness. Additionally, the combination of lorlatinib with rifampicin showed liver toxicity in studies. Inhibitors of these enzymes such as ketoconazole or grapefruit juice increase lorlatinib plasma concentrations, leading to higher toxicity.
Lorbrena was analyzed in a clinical trial of 296 patients with ALK+ NSCLC whose cancer had migrated to multiple parts of the body including the brain. A trial comparing lorlatinib with crizotinib was conducted, with a primary endpoint of "progression-free survival", which is the period of time a patient is in remission (the tumor ceases growth). Preclinical studies are investigating lorlatinib for treatment of neuroblastoma. In 2017, Pfizer announced that lorlatinib was shown to have activity against lung and brain tumors in people with ALK or ROS1 positive advanced non-small-cell lung cancer. Approval
In 2015, FDA granted Pfizer orphan drug status for lorlatinib for the treatment of NSCLC. In 2018, the FDA approved lortalinib for second- or third-line treatment of ALK-positive metastatic NSCLC. In February 2019, the European CHMP of EMA recommended the granting of a conditional marketing authorisation. In May 2019 the European Commission approved lorlatinib for the 28 countries of the EU, also as a second- or third-line treatment. References
External links
"Lorlatinib". Drug Information Portal. U.S. National Library of Medicine.