Enteral lorlatinib after alectinib as a treatment option in anaplastic lymphoma kinase‐positive non‐small cell lung cancer with triple problems: carcinomatous meningitis, poor performance status, and dysphagia—a case report

Abstract

Alectinib treatment is effective in patients with anaplastic lymphoma kinase (ALK) gene rearrangement‐positive non‐small cell lung cancer (NSCLC; hereafter ALK‐positive NSCLC) who exhibit central nervous system (CNS) relapse and poor performance status (PS). Lorlatinib treatment is effective upon failure of other ALK inhibitor‐based treatments. However, much remains unknown about the efficacy of lorlatinib in patients with ALK‐positive NSCLC, who have triple problems, carcinomatous meningitis, poor PS, and dysphagia, after alectinib treatment. Here, we report the remarkable response of a 73‐year‐old patient with ALK‐positive NSCLC showing carcinomatous meningitis due to CNS metastases, poor PS, and dysphagia to lorlatinib. Lorlatinib administration through a nasogastric tube alleviated complications related to consciousness within three days, and the patient survived for 16 months after CNS relapse. Lorlatinib could be a treatment option for patients with ALK‐positive NSCLC showing carcinomatous meningitis, poor PS, and dysphagia upon failure of other ALK inhibitor‐based treatments.

Abstract

Here, we report a case where the following were highlighted: (1) lorlatinib may be helpful in consciousness disorders due to central nervous system (CNS) metastases and carcinomatous meningitis; and (2) enteral administration could be considered for patients with anaplastic lymphoma kinase (ALK)‐positive non‐small cell lung cancer (NSCLC), for whom oral drug administration is not possible. We successfully treated a patient with ALK‐positive NSCLC with triple problems—carcinomatous meningitis, poor performance status (PS), and dysphagia—using a simple suspension method for lorlatinib administration via a nasogastric tube. The patient survived for 16 months after CNS relapse.