Lorlatinib-Related Vision Loss: Two Cases of Non-Small Cell Lung Cancer with Blindness
Received Date : 02 Aug 2022
Accepted Date : 10 Feb 2023
Available Online : 23 Feb 2023
Doi: 10.37047/jos.2022-92714 - Article's Language: EN
J Oncol Sci.
This is an open access article under the CC BY-NC-ND license
Data on the management of Grade 3-4 visual disorders due to lorlatinib remain limited. We presented two cases of Grade-4 vision loss due to lorlatinib. We interrupted lorlatinib and initiated a pulse steroid in these patients. In our first patient, visual function improvement was observed three days after treatment, with complete visual function recovery at the end of the first month. However, in the second patient, although vision loss returned to the extent of limited vision from 3 m, no further improvement was noted. In both patients, lorlatinib was continued at a reduced dose because of a favorable response and visual function improvement. In conclusion, the early recognition of vision loss and the interruption of lorlatinib may be effective in the successful recovery of visual function loss. Concurrent steroid therapy may also be beneficial.
  1. Johnson TW, Richardson PF, Bailey S, et al. Discovery of(10R)-7-amino-12-fluoro-2,10,16-trimethyl-15-oxo-10,15,16,17-tetrahydro-2H-8,4-(metheno)pyrazolo[4,3-h][2,5,11]-benzoxadiazacyclotetradecine-3-carbonitrile(PF-06463922), a macrocyclic inhibitor of anaplastic lymphoma kinase (ALK) and c-rosoncogene 1 (ROS1) with preclinical brain exposure and broad-spectrum potency againstALK-resistant mutations. J Med Chem. 2014;57(11):4720-4744. [PubMed] 
  2. Shaw AT, Bauer TM, de Marinis F,et al; CROWN Trial investigators. first-line lorlatinib or crizotinib in advancedALK-positive lung cancer. N Engl J Med. 2020;383(21):2018-2029. [Crossref]  [PubMed] 
  3. Chun SG, Iyengar P, Gerber DE,Hogan RN, Timmerman RD. Optic neuropathy and blindness associated with crizotinib fornon-small-cell lung cancer with EML4-ALK translocation. J Clin Oncol. 2015;33(5):e25-26. [Crossref]  [PubMed] 
  4. Solomon BJ, Mok T, Kim DW, et al;PROFILE 1014 Investigators. First-line crizotinib versus chemotherapy in ALK-positive lungcancer. N Engl J Med. 2014;371(23):2167-2177. Erratum in: N Engl J Med. 2015;373(16):1582. [Crossref]  [PubMed]