Lorbrena
Lorbrena (lorlatinib) is an anticancer medication that's used to treat anaplastic lymphoma kinase (ALK) positive non-small cell lung cancer (NSCLC) that has spread to other parts of the body. It’s a pill that you take by mouth, so it’s more convenient than an injection. Some common side effects Lorbrena (lorlatinib) might cause include swelling in the face or hands and feet, weight gain, or nerve pain.
What is Lorbrena (lorlatinib)?
What is Lorbrena (lorlatinib) used for?
- Anaplastic lymphoma kinase (ALK)-positive non-small cell lung cancer that has spread to other parts of the body
How Lorbrena (lorlatinib) works
Lorbrena (lorlatinib) is a targeted therapy anticancer medication that blocks a protein called anaplastic lymphoma kinase (ALK). The ALK protein is made by the ALK gene. This gene is something that everyone is born with. In people with ALK-positive NSCLC, this gene doesn’t work like it should. It ends up making abnormal proteins and causing cancer. Lorbrena (lorlatinib) works to block the ALK protein, so cancer cells can’t grow and spread as well.
Drug facts
Side effects of Lorbrena (lorlatinib)
The following side effects may get better over time as your body gets used to the medication. Let your healthcare provider know immediately if you continue to experience these symptoms or if they worsen over time.
Common Side Effects
- High cholesterol and fat levels in blood (up to 96%)
- Abnormal kidney labs (up to 81%)
- Swelling in the eyelids, face, and hands and feet (up to 57%)
- Abnormal liver protein labs (up to 52%)
- Abnormal blood cell counts (up to 52%)
- High blood sugar (up to 52%)
- Nerve pain (up to 47%)
- Weight gain (up to 38%)
- Problems with memory and attention (up to 27%)
- Trouble breathing (up to 27%)
- Tiredness (up to 26%)
- Abnormal pancreas labs (up to 24%)
- Changes in mood (up to 23%)
- Joint pain (up to 23%)
- Diarrhea (up to 22%)
- Changes in electrolyte levels (up to 21%)
Less Common Side Effects
- Cough
- Headache
- Nausea
- Changes in vision
- High blood pressure
- Constipation
- Fever
- Pain in muscles, back, arms or legs
- Dizziness
- Rash
- Vomiting
- Trouble speaking or slowed speech
- Sinus or throat infection
- Changes in sleep
- Chest pain
Lorbrena (lorlatinib) serious side effects
Contact your healthcare provider immediately if you experience any of the following.
- Suicidal thoughts and self-harm
- Severe lung problems: new or worsening breathing problems (e.g., coughing or trouble breathing) or fever
- Blocked heartbeat: feeling dizzy, faint, or a change in your heartbeat
The following Lorbrena (lorlatinib) side effects have also been reported
Side effects that you should report to your care team as soon as possible:
- Allergic reactions—skin rash, itching, hives, swelling of the face, lips, tongue, or throat
- Dry cough, shortness of breath or trouble breathing
- Heart rhythm changes—fast or irregular heartbeat, dizziness, feeling faint or lightheaded, chest pain, trouble breathing
- High blood sugar (hyperglycemia)—increased thirst or amount of urine, unusual weakness or fatigue, blurry vision
- Increase in blood pressure
- Mood and behavior changes—anxiety, nervousness, confusion, hallucinations, irritability, hostility, thoughts of suicide or self-harm, worsening mood, feelings of depression
- Pain, tingling, or numbness in the hands or feet, muscle weakness, change in vision, confusion or trouble speaking, loss of balance or coordination, trouble walking, seizures
Side effects that usually do not require medical attention (report these to your care team if they continue or are bothersome):
- Diarrhea
- Fatigue
- Joint pain
- Swelling of the ankles, hands, or feet
- Weight gain
Pros and cons of Lorbrena (lorlatinib)
Pros
- First-choice option in ALK-positive NSCLC
- Taken by mouth, so good for people who don't like needles
- Doesn’t cause sensitivity to sunlight like other medications that treat ALK-positive NSCLC
Cons
- Commonly causes side effects like changes in mood or problems with thinking
- Can cause serious breathing problems
- Might affect a male's ability to have children
Pharmacist tips for Lorbrena (lorlatinib)
- Take Lorbrena (lorlatinib) with or without food at the same time every day. Swallow the tablet whole so that the medication works properly. Don’t cut, chew, or crush the tablet.
- If you miss a dose of Lorbrena (lorlatinib) and you still have more than 4 hours until your next dose, you can take the missed dose. But if it’s less than 4 hours from your next dose, then skip the missed dose and take your dose at the next scheduled time.
- If you vomit after taking your dose, don’t take another dose to make it up. Just take your next dose at the next scheduled time.
- Taking Lorbrena (lorlatinib) can raise your blood sugar levels. This can start anytime from right after you start treatment to years after starting the medication. Your provider might ask you to check your blood sugar levels regularly during your Lorbrena (lorlatinib) treatment. - Let your provider know if you develop any symptoms of high blood sugar, like feeling more thirsty or hungry, urinating more often, feeling tired, or nausea.
- It's not known if Lorbrena (lorlatinib) can pass into your breastmilk or affect your milk production. To avoid the risk of causing harm to your baby, don't breastfeed during your treatment and for 1 week after the last dose.
- Ask your provider or pharmacist about the best way to handle and throw away Lorbrena (lorlatinib) safely. Anticancer medications can be very harmful to people who handle or come into contact with them.
Common questions about Lorbrena (lorlatinib)
Lorbrena (lorlatinib) works well to treat ALK-positive NSCLC and it’s one of the first-choice medications for this type of cancer. In a clinical trial of people newly diagnosed with NSCLC and haven’t yet received any anticancer treatment, Lorbrena (lorlatinib) lowered the risk of their cancer spreading by 72% compared with Xalkori (crizotinib), an older ALK-positive NSCLC medication. In addition, 71% of people who had NSCLC that spread to the brain (one of the common places where NSCLC tends to spread to) noticed their brain tumor disappear completely and not come back for at least a year after receiving Lorbrena (lorlatinib), compared to only 12% after receiving Xalkori (crizotinib). If you have questions about how well Lorbrena (lorlatinib) works, talk with your provider.
You should take Lorbrena (lorlatinib) as instructed by your provider. How long you take Lorbrena (lorlatinib) treatment depends on several factors, including how well the medication is working to treat your cancer. It can also depend on if you develop any serious side effects like breathing problems or blocked heartbeat. Don’t stop taking Lorbrena (lorlatinib) without first discussing it with your provider.
No. Chemotherapy medications work by directly killing cancer cells in your body. Lorbrena (lorlatinib) isn’t a chemotherapy medication. Rather, it’s a type of targeted anticancer treatment. It works more specifically to target certain proteins that are involved in the growth of cancer cells. Typically, early NSCLC is treated with chemotherapy, while targeted therapy is used more often to treat lung cancer that has spread to other parts of the body. If you’ve been diagnosed with lung cancer, ask your provider what treatment options are appropriate for you.
Yes, taking Lorbrena (lorlatinib) can raise your cholesterol levels. Higher cholesterol levels is one of the most common side effects of this medication. Having high cholesterol levels can raise your risk for other medical conditions, such as heart problems and stroke. Your provider will check your cholesterol level before you begin Lorbrena (lorlatinib), a month or two after you start treatment, then regularly after that. If your cholesterol level rises too high, your provider might prescribe medications to lower your cholesterol, or raise your dose of cholesterol-lowering medications if you’re already taking one. There are also lifestyle changes you can make to keep your cholesterol at a healthy level. For example, you can limit eating highly processed foods that are high in trans fat and sugar, such as fried foods, fruit juice, or soda. Another example is to build in at least 30 minutes of daily exercise into your routine. If you’re new to exercise, try starting with some light exercise, such as walking.
Let your provider know right away if you become pregnant while taking this medication. Based on animal studies, Lorbrena (lorlatinib) might cause harm to your unborn baby so it isn’t recommended during pregnancy. If you’re able to become pregnant, you should use birth control while taking Lorbrena (lorlatinib) and for 6 months after the last dose. Males with female partners who are able to become pregnant should use birth control while taking the medication and for at least 3 months after their last dose. If you have questions about future family planning and how Lorbrena (lorlatinib) can impact those plans, talk to your provider.
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Risks and warnings for Lorbrena (lorlatinib)
Lorbrena (lorlatinib) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Serious liver problems (from drug interactions)
During clinical trials, people who took Lorbrena (lorlatinib) while taking rifampin (Rifadin) at the same time experienced serious liver problems and had abnormal liver labs. This occurred as early as with their first dose of Lorbrena (lorlatinib). Typically, people saw their liver labs return to normal within a month after they stopped taking Lorbrena (lorlatinib).
Because of the risk of serious liver damage, you can’t take Lorbrena (lorlatinib) with other medications that can raise your risk of liver problems. Let your provider know of all medications (prescription and over-the-counter), vitamins, and herbal products you take so they can check for drug interactions.
Effects on the brain
About half of people who took Lorbrena (lorlatinib) in clinical trials experienced a wide range of side effects related to the brain. The most common side effects included problems with thinking and speech, changes in mood, and trouble sleeping. Less common, but more serious, side effects included delusions, hallucinations, and seizures. For most people, these problems typically started anywhere between a month to 3 years after they began Lorbrena (lorlatinib) treatment. Let your provider know if you develop any of these problems. Depending on how severe these problems are for you, your provider might temporarily stop Lorbrena (lorlatinib), lower your dose, or switch you to a different medication.
High cholesterol and fat in the blood
Lorbrena (lorlatinib) can raise the level of cholesterol and fat (triglycerides) in the blood. On average, people noticed this side effect about 2 weeks after starting treatment. Your provider will check your cholesterol or fat levels through lab work before you start treatment, for the first two months of treatment, and regularly after that. If the cholesterol or fat level in your blood gets too high, your provider might ask you to take medications to lower them. Depending on how high your blood cholesterol levels are, your provider might lower your dose of Lorbrena (lorlatinib).
Blocked heartbeat
Though uncommon, Lorbrena (lorlatinib) can cause a heart block (atrioventricular block), which can affect your heart beat. Your provider will monitor your heartbeat before your start treatment and periodically during treatment with an electrocardiogram (ECG). If you experience a blocked heartbeat your provider might consider placing a pacemaker, lowering your dose of Lorbrena (lorlatinib), or treating your cancer with a different medication. Let your provider know right away if you experience any symptoms of a problem with your heartbeat such as feeling dizzy or faint, or notice a change in your heartbeat.
Lung problems
Though not common, some people taking Lorbrena (lorlatinib) experienced serious lung problems, like inflammation of your lungs (pneumonitis) or interstitial lung disease. If you develop lung problems, your provider might ask you to stop taking Lorbrena (lorlatinib) permanently. Let your provider know right away if you start to have any new or worsening breathing problems (e.g., coughing, shortness of breath, or trouble breathing) or fever.
High blood pressure
People taking Lorbrena (lorlatinib) can experience high blood pressure while taking the medication. This can happen right after you start treatment or as late as 3 years after you begin Lorbrena (lorlatinib). Your provider will check your blood pressure before you start taking Lorbrena (lorlatinib) and regularly throughout treatment. If your blood pressure is high, your provider might ask you to stop taking Lorbrena (lorlatinib) temporarily. And if it’s dangerously high, your provider might lower your dose of Lorbrena (lorlatinib) or switch you to a different medication. Let your provider know right away if you experience any symptoms of high blood pressure such as headaches, dizziness, blurry vision, chest pain, or trouble breathing.
Lorbrena (lorlatinib) dosage
Typical dosage for Lorbrena (lorlatinib)
The typical starting dose of Lorbrena (lorlatinib) is 100 mg taken by mouth once daily.
Your dose might be different if you’re taking an interacting medication or if you have severe kidney problems.
Lorbrena (lorlatinib) contraindications
Contraindications are specific health conditions or situations in which a person should not take a medication due to safety concerns. If you have any of the following conditions or if any of the following apply to you, let your healthcare provider know because Lorbrena (lorlatinib) will not be safe for you to take.
- Medications that can cause serious liver damage when taken with Lorbrena (lorlatinib) (CYP3A inducers)
