ABSTRACT
Lorlatinib may offer rapid CNS symptom and imaging improvement after alectinib failure, even in elderly ALK‐positive NSCLC patients with declining performance status.
Keywords: ALK, brain metastasis, lorlatinib, NSLC, performance status
This case reports a rare, rapid CNS response within 7 days in an elderly, frail patient, suggesting lorlatinib's potential for early therapeutic benefit independent of adjunctive treatments.
An 81‐year‐old woman with anaplastic lymphoma kinase (ALK)‐positive non‐small cell lung cancer (NSCLC) was treated with alectinib for 3 years. She remained stable until 1 month prior to admission, when she developed progressive dysarthria and gait disturbance. On presentation, her Eastern Cooperative Oncology Group (ECOG) Performance Status (PS) was 3, reflecting severe functional decline. Brain computed tomography (CT) revealed multiple metastases (Figure 1A). Radiation therapy was considered but not initiated. Importantly, no corticosteroids were administered during the first 7 days. Lorlatinib was started immediately in light of prior efficacy reports post‐alectinib failure.
FIGURE 1.
(A) Axial brain CT on admission showing multiple metastases. Brain metastasis is indicated by the white arrow. (B) CT on Day 7 after lorlatinib initiation showing marked improvement. Brain metastasis is indicated by the white arrow.
By Day 7, her dysarthria and limb weakness improved markedly, with PS improving to 1. CT showed significant radiologic regression of brain metastases (Figure 1B). While lorlatinib is recognised for central nervous system (CNS) activity in ALK‐positive NSCLC [1], data from the CROWN trial indicate a median time to CNS response of 1.8–3.7 months [2]. This case underscores a rare, rapid CNS response within 7 days, even in an elderly, frail patient, suggesting lorlatinib's potential for early therapeutic benefit independent of adjunctive treatments.
Author Contributions
All authors reviewed and approved the final manuscript.
Ethics Statement
Written informed consent for publication of this case and accompanying images was obtained from the patient using the Respirology Case Reports patient consent form.
Conflicts of Interest
The authors declare no conflicts of interest.
Acknowledgements
We would like to express our gratitude to the medical staff who provided care for the patient and supported this study.
Nigi A., Iwamoto K., Itani H., and Kondou S., “Lorlatinib Achieved Rapid CNS Response in an 81‐Year‐Old NSCLC Patient With Performance Status Deterioration,” Respirology Case Reports 13, no. 8 (2025): e70320, 10.1002/rcr2.70320.
Associate Editor: Sze Shyang KHO
Funding: The authors received no specific funding for this work.
Data Availability Statement
The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.
References
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Data Availability Statement
The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.