FDA Approves Lorlatinib for Second- or Third-line Treatment of ALK-positive Metastatic NSCLC

The indication is approved under accelerated approval based on tumour response rate and duration of response

On 2 November 2018, the US Food and Drug Administration (FDA) granted accelerated approval to lorlatinib (LORBRENA, Pfizer, Inc.) for patients with anaplastic lymphoma kinase (ALK)-positive metastatic non-small cell lung cancer (NSCLC) whose disease has progressed on crizotinib and at least one other ALK inhibitor for metastatic disease or whose disease has progressed on alectinib or ceritinib as the first ALK inhibitor therapy for metastatic disease. 

Approval was based on a subgroup of 215 patients with ALK-positive metastatic NSCLC, previously treated with one or more ALK kinase inhibitors, enrolled in a non‑randomised, dose-ranging and activity-estimating, multi‑cohort, multicentre study (Study B7461001; NCT01970865). The major efficacy measures were overall response rate (ORR) and intracranial ORR, according to RECIST v1.1, as assessed by an independent central review committee. 

The ORR was 48% (95% CI: 42, 55), with 4% complete and 44% partial responses. The estimated median response duration was 12.5 months (95% CI: 8.4, 23.7). The intracranial ORR in 89 patients with measurable lesions in the CNS according to RECIST v1.1 was 60% (95% CI: 49, 70) with 21% complete and 38% partial responses. The estimated median response duration was 19.5 months (95% CI: 12.4, not reached). 

Most common adverse reactions (incidence ≥20%) in patients receiving lorlatinib were oedema, peripheral neuropathy, cognitive effects, dyspnoea, fatigue, weight gain, arthralgia, mood effects, and diarrhoea. The most common laboratory abnormalities were hypercholesterolemia and hypertriglyceridemia. 

The recommended lorlatinib dose is 100 mg orally once daily. 

Full prescribing information for LORBRENA is available here.

This indication is approved under accelerated approval based on tumour response rate and duration of response. Continued approval for this indication may be contingent upon verification and description of clinical benefit in a confirmatory trial. FDA granted this application priority review and granted breakthrough therapy designation for this development programme. 

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