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Vol.61 No.4 contents | Japanese/English |
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- Case Report -
Successful Low-dose Alternate-day Treatment with Lorlatinib in an Elderly Patient with Anaplastic Lymphoma Kinase-positive Metastatic Non-small-cell Lung Cancer
Minori Hirose1, Shinya Sakata1, Taiyo Komatsu1, 2, Chieko Yoshida1, Yusuke Tomita1, Sho Saeki1, Shinichiro Okamoto1, Takuro Sakagami11Department of Respiratory Medicine, Kumamoto University Hospital, Japan, 2Department of Internal Medicine, Amakusa Central General Hospital, Japan
Background. After the approval of the first-generation anaplastic lymphoma kinase (ALK) inhibitor crizotinib and the second-generation agents alectinib and ceritinib, the third-generation agent lorlatinib was approved in Japan in 2018 as a molecular-targeted drug for ALK fusion gene-positive non-small-cell lung cancer (NSCLC). We herein report an elderly patient with ALK fusion gene-positive NSCLC who experienced adverse events during second-line lorlatinib treatment and was successfully treated with reduced-dose (50 mg/day) lorlatinib every other day. Case. An 82-year-old Japanese man was diagnosed with adenocarcinoma of the lung (pT2aN2M0 stage IIIA), and 5 years after left total pneumonectomy, he showed recurrence with multiple lymph node metastases, multiple bone metastases, and pleural dissemination. He was positive for the ALK fusion gene and started treatment with alectinib as the first-line therapy but relapsed 3 years and 6 months later. We administered lorlatinib (100 mg/day) as second-line therapy. Due to the development of visual hallucinations, this treatment was discontinued. After the improvement of the hallucinations, we restarted treatment with the dose of lorlatinib reduced to 50 mg/day. The visual hallucinations recurred, and lorlatinib was stopped again. After the hallucinations improved, we initiated alternate-day treatment with 50 mg/day lorlatinib. The antitumor effect has been maintained for over 12 months with no hallucinations. Conclusion. For patients with uncontrollable visual hallucinations as an adverse event during lorlatinib treatment, alternate-day treatment with 50 mg/day lorlatinib may be effective.
key words: ALK, Elderly, Low-dose alternate-day, Lorlatinib, Non-small-cell lung cancer
Received: February 22, 2021
Accepted: April 12, 2021
JJLC 61 (4): 336-341, 2021
