The recommended lorlatinib dose is 100 mg orally once daily. The most common adverse reactions (incidence ≥20%), including Grade 3-4 laboratory abnormalities, in patients receiving lorlatinib, were edema, peripheral neuropathy, weight gain, cognitive effects, fatigue, dyspnea, arthralgia, diarrhea, mood effects, hypercholesterolemia, hypertriglyceridemia, and cough. The duration of intracranial response was ≥ 12 months in 79% and 0% of patients in the lorlatinib and crizotinib arms, respectively. Among these patients, the intracranial ORR, as assessed by the BICR, was 82% (95% CI: 57, 96) in the lorlatinib arm and 23% (95% CI: 5, 54) in the crizotinib arm. There were 17 patients in the lorlatinib arm and 13 in the crizotinib arm with measurable CNS lesions based on baseline brain imaging. Overall survival data were immature at the PFS analysis.Ĭentral nervous system (CNS) involvement was assessed in all patients. Median PFS was not estimable in the lorlatinib arm and was 9.3 months (95% CI: 7.6, 11.1) for those treated with crizotinib. ![]() Study B7461006 demonstrated an improvement in progression-free survival (PFS) as assessed by blinded independent central review (BICR), with a hazard ratio of 0.28 (95% CI: 0.19, 0.41 p<0.0001). Patients were randomized 1:1 to receive lorlatinib 100 mg orally once daily (n=149) or crizotinib 250 mg orally twice daily (n=147). Patients were required to have ALK-positive tumors detected by the VENTANA ALK (D5F3) CDx assay. ![]() This current approval is based on data from Study B7461006 (NCT03052608), a randomized, multicenter, open-label, active-controlled trial conducted in 296 patients with ALK-positive metastatic NSCLC who had not received prior systemic therapy for metastatic disease. Lorlatinib received accelerated approval in November 2018 for the second- or third-line treatment of ALK-positive metastatic NSCLC. The FDA also approved the Ventana ALK (D5F3) CDx Assay (Ventana Medical Systems, Inc.) as a companion diagnostic for lorlatinib. On March 3, 2021, the Food and Drug Administration granted regular approval to lorlatinib (Lorbrena, Pfizer Inc.) for patients with metastatic non-small cell lung cancer (NSCLC) whose tumors are anaplastic lymphoma kinase (ALK)-positive, detected by an FDA-approved test.
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