LORVIQUA® (lorlatinib) as monotherapy is indicated for the first-line treatment of adult patients with anaplastic lymphoma kinase (ALK)-positive advanced non-small cell lung cancer (NSCLC) or for patients with ALK-positive metastatic NSCLC whose disease has progressed after alectinib or ceritinib as the first ALK tyrosine kinase inhibitor (TKI) therapy, or crizotinib and at least one other ALK TKI1
Recommended Dosing Dose Modification

Dosing

Dose Modification1

  • Dose modifications may be required based on individual safety and tolerability


Tablets not actual size
*Until disease progression or unacceptable toxicity

Dosing modification based on specific adverse events can be found here.
  • Permanently discontinue LORVIQUA® in patients who are unable to tolerate the 50 mg dose once daily

Contraindications1

  • LORVIQUA® is contraindicated in patients taking strong CYP3A inducers, due to the potential for serious hepatotoxicity

Concurrent use of strong CYP3A inhibitors1

  • Concurrent use of LORVIQUA® with strong CYP3A inhibitors may increase lorlatinib plasma concentrations
  • An alternative concomitant medicinal product with less potential to inhibit CYP3A should be considered
  • If a strong CYP3A inhibitor must be administered concomitantly, the starting LORVIQUA® dose of 100 mg once daily should be reduced to once daily 75 mg dose
  • If concurrent use of a strong CYP3A inhibitor is discontinued, LORVIQUA® should be resumed at the dose used prior to the initiation of the strong CYP3A inhibitor and after a washout period of 3 to 5 half-lives of the strong CYP3A inhibitor


Hepatic impairment1

  • No dose adjustments are recommended for patients with mild hepatic impairment.
  • Limited information is available for lorlatinib in patients with moderate or severe hepatic impairment. Therefore, LORVIQUA® is not recommended in patients with moderate to severe hepatic impairment​​​​​​​

Renal impairment1

  • No dose adjustment is needed for patients with mild or moderate renal impairment [absolute estimated glomerular filtration rate (eGFR): ≥30 mL/min]
  • A reduced dose of LORVIQUA® is recommended in patients with severe renal impairment (absolute eGFR <30 mL/min), e.g., a starting dose of 75 mg taken orally once daily​​​​​​​

Elderly (>65 years)1

  • The limited data on the safety and efficacy of LORVIQUA® in patients aged 65 years and older do not suggested that a dose adjustment is required in elderly patients​​​​​​​

Paediatric patients1

  • The safety and efficacy of LORVIQUA® in paediatric patients has not been established

CYP3A, cytochrome P4503A.

References

  1. Pfizer. LORVIQUA® (lorlatinib) Prescribing Information, Available from:  http://labeling.pfizer.com/ShowLabeling.aspx?id=12540 Accessed 6 January 2022.

The use of lorlatinib has been associated with increases in serum cholesterol and triglycerides. Serum cholesterol and triglycerides should be monitored before the initiation of lorlatinib; 2, 4, and 8 weeks after initiating lorlatinib, and periodically thereafter. Initiation, or increase in the dose, of lipid-lowering agents is required.
Central nervous system (CNS) effects have been observed in patients receiving lorlatinib including seizures, psychotic effects, changes in cognitive function, mood (including suicidal ideation), mental status, sleep, and speech. Dose modification or discontinuation may be required for those patients who develop CNS effects.
PR interval prolongation and atrioventricular (AV) block events have been reported in patients receiving lorlatinib. Monitor electrocardiogram (ECG) prior to initiating lorlatinib and monthly thereafter, particularly in patients with predisposing conditions to the occurrence of clinically significant cardiac events. Dose modification may be required for those patients who develop AV block.
Elevations of lipase and/or amylase have occurred in patients receiving lorlatinib. Median time of occurrence of increase in serum lipase and amylase is 70 days (range: 7 days to 696 days) and 41 days (range: 7 days to 489 days), respectively. Risk of pancreatitis should be considered in patients receiving lorlatinib due to concomitant hypertriglyceridemia and/or a potential intrinsic mechanism. Patients should be monitored for lipase and amylase elevations prior to the start of lorlatinib treatment and regularly thereafter as clinically indicated.
Severe or life threatening pulmonary adverse drug reactions consistent with ILD/pneumonitis have occurred with lorlatinib. Any patient who presents with worsening of respiratory symptoms indicative of ILD/pneumonitis (e.g., dyspnea, cough and fever) should be promptly evaluated for ILD/pneumonitis. Lorlatinib should be withheld and/or permanently discontinued based on severity.
Hypertension has been reported in patients receiving lorlatinib. Blood pressure should be controlled prior to the initiation of lorlatinib. Blood pressure should be monitored after 2 weeks and at least monthly thereafter during treatment with lorlatinib. Lorlatinib should be withheld and resumed at a reduced dose or permanently discontinued based on severity.
Hyperglycemia has occurred in patients receiving lorlatinib. Fasting serum glucose should be assessed prior to the initiation of lorlatinib and monitored periodically thereafter. Lorlatinib should be withheld and resumed at a reduced dose or permanently discontinued based on severity.
Concomitant use of any strong CYP3A inducer is contraindicated. Any strong CYP3A inducers have to be discontinued for at least 3 plasma half-lives of the strong CYP3A inducer before lorlatinib treatment is started. No clinically meaningful changes in liver function tests were seen in healthy subjects after receiving a combination of lorlatinib with the moderate CYP3A inducer modafinil.
Women of childbearing potential should be advised to avoid getting pregnant while receiving lorlatinib. Male fertility may be compromised during treatment with lorlatinib. Men should seek advice on effective fertility preservation before treatment.
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​​​​​​​LORVIQUA® Efficacy

​​​​​​​LORVIQUA
® Safety Profile
LORVIQUA® Dosing and Therapy
​​​​​​​Management
Click here for LORVIQUA® Prescribing Information

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