An update on lorlatinib: a novel first line treatment for -positive advanced lung cancer.

Introduction: Anaplastic lymphoma kinase () tyrosine kinase inhibitors (TKIs) have significantly improved the prognosis of -rearranged non-small cell lung cancer (NSCLC), but these patients will eventually develop resistance and progression of disease after 10 months of first-generation and more than 30 months after second-generation TKIs. Lorlatinib is a third-generation highly selective ALK-TKI capable of inducing significant and durable CNS responses and overcoming known resistance mutations.

Areas Covered: This review summarizes the mechanism of action, efficacy, and safety of lorlatinib in -positive NSCLC. The authors provide their expert opinions on the use of this drug, including its future prospects.

Expert Opinion: Lorlatinib has shown good efficacy and safety in -positive NSCLC patients progressing to first- and second-generation ALK-TKIs. The phase III trial CROWN evaluating lorlatinib as first-line therapy has provided promising results; however, the comparing arm was crizotinib, supplanted now by second-generation agents. Whether lorlatinib can replace them as upfront strategy is a relevant question that still remains open. In our opinion, longer follow-up and face-to-face studies are required to determine which is the best treatment sequence strategy. The advent of liquid biopsy will contribute to treatment tailoring according to the genomic profile at progression.