Lung Cancer is a disease with diversity. ALK and ROS1 positive lung cancer constitute one end of the spectrum with a favorable outcome. Lorlatinib has been approved in November,2018 for disease progressing on first and second line ALK inhibitor. We are presenting the outcome data of Lorlatinib in subsequent lines of therapy.
We retrospectively collected data from Medical Oncology department for ALK and ROS1 positive patients who received lorlatinib post progression on initial therapy.The demographic details, histology, prior treatment, clinical and radiological response, date of disease progression, date of death and toxicity data were collected.We included patients who were started on treatment on 31st December,2019 or earlier.
There were 41 patients in the database who received Lorlatinib.The median age was 47 years (range 23-68 ), with 54% being male. Forty one percent patients have comorbidities; the most common being hypertension and diabetes and 81% patients were of ECOG-PS-1. Three patients were ROS1 positive. Twenty four patients (59%) received two prior TKIs. The most common site of metastasis before starting Lorlatinib were brain(59%) and bone(57%).All patient except one received prior WBRT with 4 being irradiated twice. The median follow up period was 16 months (95% CI: 14.4-17.5).Seventy three percent showed clinical response to therapy with median PFS and OS of 16 months (95% CI 14.0-18.2) and 23 months (95% CI 14.6-31.3) respectively. The most common site of progression was lung (67%) and pleural effusion(33%). Ten out of eighteen patient who progressed received subsequent therapy. The most common grade 3 and above toxicity were hypercholesterolemia and hypertriglyceridemia. Three patients underwent dose reduction.
Previous lines of therapy n (%) 1 5 (12.2) 2 17 (41.5) 3 11 (26.8) >4 8 (19.5) >1 TKI 24 (58.5) Response Complete response 1 (2.4) Partial response 8 (19.5) Stable disease 20 (48.8) Progressive disease 5 (12.2) Non evaluable 7 (17) Clinical benefit Yes 30 (73) No 11 (27)
Lorlatinib seems to be a potent drug in subsequent lines with tolerable side effects.
The authors.
Has not received any funding.
V. Noronha: Research grant/Funding (institution): Dr. Reddy’s Laboratories; Research grant/Funding (institution): Amgen; Research grant/Funding (institution): Sanofi Aventis. K. Prabhash: Research grant/Funding (institution): Biocon Ltd; Research grant/Funding (institution): Dr. Reddy’s Laboratories; Research grant/Funding (institution): Fresenius Kabi India Pvt. Ltd.; Research grant/Funding (institution): Alkem Laboratories; Research grant/Funding (institution): Natco Pharma Ltd.; Research grant/Funding (institution): BDR Pharmaceutics Intl Pvt. Ltd.; Research grant/Funding (institution): Roche Holding AG. All other authors have declared no conflicts of interest.