Lorlatinib (Lorviqua)

Lorlatinib is a type of targeted cancer drug . It is pronounced lor-la-tih-nib.

Lorlatinib is a treatment for non small cell lung cancer with an anaplastic lymphoma kinase (ALK) gene change. It is also called ALK positive non small cell lung cancer.

You might have lorlatinib for non small cell lung cancer if you had treatment with an ALK targeted drug before and your cancer has started to grow again (progressed).

In Scotland, you can also have lorlatinib for ALK positive advanced non small cell lung cancer previously not treated with an ALK targeted drug.

How does lorlatinib work?

Lorlatinib is a type of targeted drug called a tyrosine kinase inhibitor (TKI) . Tyrosine kinases are proteins that cells use to signal to each other to grow. They act as chemical messengers. Blocking these signals helps to slow or stop the cancer from growing.

There are several different tyrosine kinases. You have tests on your cancer cells before you have this treatment. The tests look for changes in these proteins and genes. With lorlatinib they look for the ALK gene change.

How do you take lorlatinib?

You take lorlatinib as tablets that you swallow. You swallow the tablets whole with a glass of water. You can take them with or without food.

You should take the right dose, not more or less.

Talk to your healthcare team before you stop taking a cancer drug, or if you miss a dose.

How often do you take lorlatinib?

You take lorlatinib once a day.

You usually take it for as long as it is working and you don't have too many side effects.

Tests

You have blood tests before and during your treatment. They check your levels of blood cells and other substances in the blood. They also check how well your liver and kidneys are working.

What are the side effects of lorlatinib?

Side effects can vary from person to person. They also depend on what other treatment you are having. 

When to contact your team

Your doctor, nurse, or pharmacist will go through the possible side effects. They will monitor you closely during treatment and check how you are at your appointments. Contact your advice line as soon as possible if:

• you have severe side effects 

• your side effects aren’t getting any better

• your side effects are getting worse

We haven't listed all the side effects here. Remember it is very unlikely that you will have all of these side effects, but you might have some of them at the same time.

Common side effects

These side effects happen in more than 10 in 100 people (more than 10%). You might have one or more of them. They include:

Breathlessness and looking pale

You might be breathless and look pale due to a drop in red blood cells. This is called anaemia.

High levels of cholesterol and fats

This treatment can cause high levels of cholesterol or fats in your blood. You will have regular tests to check your blood cholesterol and fat levels. Your doctor might prescribe medicines to lower the levels in your blood.

Mental health changes

You might have mood changes, including feeling very low (depressed), or extremely happy and excited (euphoric), have mood swings or thoughts about taking your own life. Other mental health changes may include feeling irritable, anxious and panicky, angry, aggressive or having changes to your personality.

Less commonly, you might hear or see things that appear to be real but only exist in your mind (a hallucination) or you might believe something is true or real while it is false or unreal (a delusion).

Talk to your healthcare team or anyone you trust if you have any of these mental health changes and find it hard to cope.

Sleeping problems

You might fall asleep during the day (hypersomnia), have problems falling and staying asleep at night (insomnia) or feel drowsy.

It is important not to use machinery when feeling sleepy or drowsy. Speak to your doctor or nurse if you have sleeping problems. They can give advice on what to do. 

Thinking, attention and memory problems (cognitive disorder)

This treatment may cause changes to your ability to think, keep your attention or remembering things. Talk to your healthcare team if you notice any of these changes.

Nerve changes

Numbness or tingling in fingers or toes is often temporary and can improve after you finish treatment. Tell your doctor if you're finding it difficult to walk or complete fiddly tasks such as doing up buttons. 

You might experience pain, an unpleasant feeling or nothing when touching something. Or you might experience a pricking or burning sensation without being touched. Other nerve changes include a feeling of insects crawling under your skin, nerve pain or weak muscles.

Headaches

Tell your healthcare team if you keep getting headaches. They can give you painkillers to help.

Eyesight changes

This treatment may cause double, blurred or loss of vision. Other changes may include seeing a flash of light or something floating. Your eyes might be sensitive to bright light or you might be less able to make out shapes and details of objects from a distance.

Lung changes

Lung changes include difficulty breathing or having a cough.

Less commonly, you might have inflammation of the lung tissue (pneumonitis) or changes that cause scarring of the lung, making it hard for the lungs to get enough oxygen.

Diarrhoea or constipation

Tell your healthcare team if you have diarrhoea or constipation. They can give you medicine to help. 

Feeling or being sick

Feeling or being sick is usually well controlled with anti sickness medicines. It might help to avoid fatty or fried foods, eat small meals and snacks and take regular sips of water. Relaxation techniques might also help.

It is important to take anti sickness medicines as prescribed even if you don’t feel sick. It is easier to prevent sickness rather than treat it once it has started.

Changes to the pancreas

This treatment can cause an increase in the levels of digestive enzymes called lipase and amylase. These enzymes are made by an organ called the pancreas. Lipase helps to digest fats and amylase carbohydrates. You will have regular tests to measure your levels of these enzymes.

Rarely, you might have inflammation of the pancreas (pancreatitis). Symptoms include tummy (abdominal) pain, fever and feeling or being sick.

Liver changes

You might have liver changes that are usually mild and unlikely to cause symptoms. They usually go back to normal when treatment finishes. You have regular blood tests to check for any changes in the way your liver is working.

Skin changes

You might notice skin changes, such as an itchy rash or a rash similar to acne on your face, neck and trunk. Or you might have flat, red areas on the skin that is covered with small bumps.

Tell your doctor if you have any rashes or itching. Don't go swimming if you have a rash because the chlorine in the water can make it worse.

If your skin gets dry or itchy, using unperfumed moisturising cream may help. Check with your doctor or nurse before using any creams or lotions. Wear a high factor sunblock if you’re going out in the sun.

Muscle and joint changes

You may get muscle or joint pain.

Tell your doctor or nurse so they can give you painkillers and advice on what to do to help ease the pain.

Less commonly, you might have increased levels of a substance called creatine phosphokinase found in muscles. You will have blood tests to check on your levels.

General swelling

A build up of fluid (oedema) that may cause swelling in your arms, hands, ankles, legs, face and other parts of the body. Contact your doctor if this happens to you.

Tiredness and weakness

You might feel very tired and as though you lack energy.

Various things can help you to reduce tiredness and cope with it, for example exercise. Some research has shown that taking gentle exercise can give you more energy. It is important to balance exercise with resting.

Dizziness

This drug might make you feel dizzy. You might also feel dizzy when standing or moving around. Or it might feel like the world is spinning.

Don’t drive or operate machinery if you have this.

Weight gain

You may gain weight while having this treatment. You may be able to control it with diet and exercise. Tell your healthcare team if you are finding it difficult to control your weight. 

Occasional side effects

• changes to your blood sugar levels (hyperglycaemia). Symptoms might include feeling very thirsty, a dry mouth, passing urine very often, feeling tired, blurred vision, weight loss, feeling or being sick, and fruity smelling breath
• difficulty speaking or slow speech. Contact your healthcare team if you have this 
• a change in your heart rhythm called an atrioventricular block. Symptoms may include feeling light headed or faint, having chest pain, shortness of breath or feeling very tired. You will have tests to check how well your heart works

Coping with side effects

We have more information about side effects and tips on how to cope with them.

What else do you need to know?

Other medicines, food and drink

Cancer drugs can interact with medicines, herbal products, and some food and drinks. We are unable to list all the possible interactions that may happen. An example is grapefruit or grapefruit juice which can increase the side effects of certain drugs.

Tell your healthcare team about any medicines you are taking. This includes vitamins, herbal supplements and over the counter remedies. Also let them know about any other medical conditions or allergies you may have.

Loss of fertility

Men might not be able to father a child after treatment with this drug. Talk to your doctor before starting treatment if you think you may want to have a baby in the future.

You might be able to store sperm before starting treatment. But these services are not available in every hospital, so you would need to ask your doctor about this.

It is not known whether this treatment affects fertility in women. Talk to your doctor before starting treatment if you think you may want to have a baby in the future.

Contraception and pregnancy

This treatment may harm a baby developing in the womb. It is important not to become pregnant or father a child while you are having treatment.

Women must not become pregnant for at least 5 weeks after the end of treatment. Men should not father a child for at least 14 weeks after treatment.

Talk to your doctor or nurse about effective contraception before starting treatment. Let them know straight away if you or your partner falls pregnant while having treatment.

Breastfeeding

Don’t breastfeed during this treatment and for 1 week after your last dose, because the drug may come through into your breast milk.

Treatment for other conditions

If you are having tests or treatment for anything else, always mention your cancer treatment. For example, if you are visiting your dentist.

Immunisations

Unless discussed with your healthcare team, don’t have immunisations with live vaccines while you’re having treatment and for up to 12 months afterwards. The length of time depends on the treatment you are having. Ask your doctor or pharmacist how long you should avoid live vaccinations.

In the UK, live vaccines include rubella, mumps, measles, BCG, yellow fever and one of the shingles vaccines called Zostavax.

You can have:

• other vaccines, but they might not give you as much protection as usual
• the flu vaccine (as an injection)
• the coronavirus (COVID-19) vaccine - talk to your doctor or pharmacist about the best time to have it in relation to your cancer treatment

Members of your household who are aged 5 years or over are also able to have the COVID-19 vaccine. This is to help lower your risk of getting COVID-19 while having cancer treatment and until your immune system recovers from treatment.

Contact with others who have had immunisations - You can be in contact with other people who have had live vaccines as injections. Avoid close contact with people who have recently had live vaccines taken by mouth (oral vaccines) such as the oral typhoid vaccine. Sometimes people who have had the live shingles vaccine can get a shingles type rash. If this happens they should keep the area covered.

If your immune system is severely weakened, you should avoid contact with children who have had the flu vaccine as a nasal spray as this is a live vaccine. This is for 2 weeks following their vaccination.

Babies have the live rotavirus vaccine. The virus is in the baby’s poo for about 2 weeks and could make you ill if your immunity is low. Get someone else to change their nappies during this time if you can. If this isn't possible, wash your hands well after changing their nappy.

More information about this treatment

For further information about this treatment and possible side effects go to the electronic Medicines Compendium (eMC) website. You can find the patient information leaflet on this website.

You can report any side effect you have to the Medicines Health and Regulatory Authority (MHRA) as part of their Yellow Card Scheme.