Lorlatinib

Lorlatinib comes as tablets, so you can take it at home. Lorlatinib is given on its own. 

During treatment, you usually see a:

• cancer doctor
• cancer nurse or specialist nurse
• specialist pharmacist.

This is who we mean when we mention doctor, nurse or pharmacist in this information.

Before and during treatment, a nurse or person trained to take blood (phlebotomist) will take a blood sample from you. This is to check that it is safe for you to have treatment.

You will speak to a doctor, nurse or pharmacist before you have treatment. They will ask how you have been feeling.

You usually take lorlatinib tablets once a day. A nurse or pharmacist will give you the tablets to take home. Always take them exactly as explained. This is important to make sure they work as well as possible for you. You may be given tablets of different strengths.

Usually you will take lorlatinib for as long as it is working for you and side effects can be managed. Do not stop taking it without your doctor’s advice.

Your nurse or pharmacist may also give you anti-sickness drugs and other medicines to take home. Take all of these exactly as they have been explained to you.

Take the lorlatinib tablets at the same time every day. This can be at any time that works for you but should always be at the same time each day.

You can take lorlatinib tablets with or without food. Swallow the tablets whole with a glass of water. Do not chew or crush them.

You should not eat grapefruit or drink grapefruit juice when taking lorlatinib. This is because it may increase the risk of side effects.

If you forget to take the tablets, you should take the missed dose as soon as possible. If it is less than 4 hours until your next dose, do not take the missed dose. Do not take a double dose to make up for the missed dose.

Other things to remember about your tablets:

• Wash your hands after taking your tablets.
• Other people should avoid direct contact with the targeted therapy drugs.
• Keep them in the original package and at room temperature, away from moisture, heat and direct sunlight.
• Keep them safe, somewhere children cannot see or reach them.
• If you are sick just after taking the tablets, contact the hospital. Do not take an extra dose.
• If your treatment is stopped, return any unused tablets to the pharmacist.

This treatment can reduce the number of red blood cells in your blood. Red blood cells carry oxygen around the body. If the number of red blood cells is low, this is called anaemia. You may feel:

• very low in energy
• breathless 
• dizzy and light-headed. 

If you have these symptoms, contact the hospital straight away on the 24-hour number. You may need treatment for anaemia. If you are very anaemic, you may need a drip to give you extra red blood cells. This is called a blood transfusion.

This treatment can raise the level of cholesterol and other fats in the blood. You will have regular blood tests to check the levels of these fats.

Your doctor may give you medicines to control the levels of fat in the blood. 

Lorlatinib may affect the nervous system. You may:

• have memory problems 
• feel confused 
• have disturbed sleep 
• have difficulty speaking or slow or slurred speech 
• see or believe things that are not real (hallucinations or delusions) – this is rare. 

Contact the hospital straight away on the 24-hour number you have if you have any of these side effects. 

This treatment can affect the lungs. Tell your doctor straight away if you develop:

• a cough
• chest pain
• breathlessness

You should also tell them if any existing breathing problems get worse. You may have tests to check your lungs. You may need treatment with antibiotics and steroids.

This treatment may affect the nerves in your fingers and toes. This can cause numbness, tingling or pain in your hands or feet. This is called peripheral neuropathy. You might find it hard to do fiddly tasks such as fastening buttons or tying shoelaces.

If you have these symptoms, always tell your doctor, nurse or pharmacist. They sometimes need to change the drug or the dose of the drug. The symptoms usually improve slowly after treatment ends. But for some people they continue and are a long-term side effect of treatment.

This treatment may cause diarrhoea. Diarrhoea means passing more stools (poo) than is normal for you, or having watery or loose stools. You may also have stomach cramps. If you have a stoma, it may be more active than usual. 

If you are passing loose stools 3 or more times a day and this is not normal for you, contact the hospital as soon as possible on the 24-hour number. Follow the advice they give you about:

• taking anti-diarrhoea medicines 
• drinking enough fluids to keep you hydrated and to replace lost salts and minerals
• any changes to your diet that might help. 

They might also ask you for a specimen of your stool to check for infection.

This treatment can cause constipation. Constipation means that you are not able to pass stools (poo) as often as you normally do. It can become difficult or painful. Here are some tips that may help:

• Drink at least 2 litres (3½ pints) of fluids each day.
• Eat high-fibre foods, such as fruit, vegetables and wholemeal bread.
• Do regular gentle exercise, like going for short walks.

If you have constipation, contact the hospital on the 24-hour number for advice. They can give you drugs called laxatives to help. 

If you have not been able to pass stools for over 2 days and are being sick, contact the 24-hour number straight away. 

This treatment can affect your eyesight. Contact your doctor if you have: 

• any difficulty seeing out of one or both eyes 
• double vision 
• feel that you see flashes of light. 

Feeling tired is a common side effect of this treatment. Tell your cancer team if you find this difficult to manage or if it gets worse. Try to pace yourself and plan your day so you have time to rest. Gentle exercise, like short walks, can help you feel less tired.

If you feel sleepy, do not drive or use machinery.

This treatment can affect the way your heart works. Your doctor may do tests to see how well your heart is working. You may have these tests before, during and sometimes after treatment.  

Contact a doctor straight away if you: 

• feel light-headed, dizzy or faint 
• feel breathless  
• feel your heart is beating too fast or too slowly. 

Other conditions can cause these symptoms. But it is important to get them checked by a doctor.

This treatment may cause headaches. If you have headaches, tell your doctor, nurse or pharmacist. They can give you advice about painkillers that may help. Tell them if the headache does not get better, or gets worse.

You may gain weight when you are having this treatment. Your nurse or doctor may check your weight at appointments. They can give you advice and refer you to a dietitian if needed. Eating healthily and being active can help you keep to a healthy weight.

Lorlatinib can cause high blood pressure in some people. Tell your doctor, nurse or pharmacist if you already have high blood pressure before starting this treatment.

Your blood pressure will be checked regularly when you are taking lorlatinib. Tell your doctor if you have: 

• headaches 
• dizziness
• blurred vision.

If you develop high blood pressure, you will be prescribed medicines to help control it.

Cancer and some cancer treatments can increase the risk of a blood clot. Contact the hospital straight away on the 24-hour number if you have any of these symptoms during or after treatment:

• throbbing pain or swelling in a leg or arm
• reddening of the skin in the area – if you have black or brown skin, this can be harder to notice, but the skin might become darker
• suddenly feeling breathless or coughing.

Always call 999 if you have:

• chest pain
• difficulty breathing.

A blood clot is serious, but it can be treated with drugs called anticoagulants. These thin the blood. Your doctor, nurse or pharmacist can give you more information about preventing and treating blood clots.

This drug contains lactose. If you have a lactose intolerance, talk to your doctor before you start taking this treatment.

Some medicines can affect how this treatment works or be harmful while you are having it. Always tell your cancer doctor, nurse or pharmacist about any drugs you are taking or planning to take, such as: 

• medicines you have been prescribed
• medicines you buy in a shop, pharmacy or online
• vitamins or supplements 
• herbal drugs and complementary or homeopathic therapies
• recreational drugs – for example, cannabis.

Doctors usually recommend that people with cancer have vaccinations for flu and for coronavirus (covid). These help reduce your risk of serious illness from these infections. Most people can have these vaccines, including people with weak immune systems.

If your immune system is weak, you should not have live vaccinations. Live vaccines can make you unwell because they contain a very weak version of the illness they will protect you against. Live vaccines include Zostavax^®, which is a shingles vaccine, and the yellow fever vaccine.

It is important to ask your doctor, nurse or pharmacist for advice about having vaccinations. They can explain what vaccines are right for you and when it is best to have them.

Your doctor will advise you not to get pregnant or make someone pregnant while having this treatment. The drugs may harm a developing baby.

It is important to use highly effective contraception during your treatment and for at least 5 weeks after treatment finishes. For example, use a double barrier method such as a condom and a diaphragm. You should use a non-hormonal method of contraception as lorlatinib can affect how hormonal contraceptives work. Your doctor, nurse or pharmacist can tell you more about this. 

Some cancer drugs can affect whether you can get pregnant or make someone pregnant. If you are worried about this, it is important to talk with your doctor before you start treatment.

You are advised not to breastfeed while having this treatment, or for some time after treatment ends. This is because the drugs could be passed to the baby through breast milk. 

Your doctor, nurse or pharmacist can give you more information.

If you need medical treatment for any reason other than cancer, always tell the healthcare professional that you are having cancer treatment. Give them the contact details for your cancer doctor or cancer team so they can ask for advice.

If you have appointments with a dentist, always tell them you are having cancer treatment. Talk to your cancer team before you have any dental treatment.