Lorlatinib (Lorbrena®)

SELF ADMINISTRATION - ORAL

Indications for Prior Authorization: 
  • Indicated for the treatment of patients with anaplastic lymphoma kinase (ALK)-positive metastatic non-small cell lung cancer (NSCLC) whose disease has progressed while on
    • Xalkori® (crizotinib) and at least one other ALK inhibitor for metastatic disease; OR
    • Alecensa® (aletinib) as the first ALK inhibitor therapy for the metatstaic disease; OR
    • Zykadia® (ceritinib) as the first ALK inhibitor therapy for metastatic disease.
The following criteria must be met:
  • Prescribed by or in consultation with an oncologist, AND
  • The patient is at least 18 years of age or older, AND
  • Chart note documentation confirms the patient has anaplastic lymphoma (ALK)-positive metastatic NSCLC, AND
  • The patient meets one of the following criteria:
    • The patient has disease progression on Xalkori® (crizotinib) AND at least one other ALK inhibitor (e.g. Zykadia® [ceritinib], Alecensa® [alectinib], Alunbrig™ [brigatinib]); OR
    • The patient has disease progression on Alecensa® (alectinib) as the first ALK inhibitor therapy, OR
    • The patient has disease progression on Zykadia® (certitinib) as the first ALK inhibitor therapy.
  • Contraindicated in patients taking strong CYP3A inducers due to potential for serious hepatotoxicity
Dosing:
  • 100 mg orally once daily
  • Lorbrena® may be dose adjusted, withheld or discontinued for adverse reactions
Approval: 
  • 1 year 

Last review date: December 4, 2019

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