Bilateral optic neuropathy associated with lorlatinib monotherapy for ALK-positive metastatic lung adenocarcinoma

Alan W Kong; Alexander R Engelmann; Mahdieh Hosseini; Laura Bonelli

doi:10.1016/j.ajoc.2024.102063

Bilateral optic neuropathy associated with lorlatinib monotherapy for ALK-positive metastatic lung adenocarcinoma

Am J Ophthalmol Case Rep. 2024 Apr 25:34:102063. doi: 10.1016/j.ajoc.2024.102063. eCollection 2024 Jun.

Authors

Alan W Kong¹, Alexander R Engelmann¹, Mahdieh Hosseini², Laura Bonelli¹

Affiliations

¹ University of California Los Angeles, Stein Eye Institute, Department of Ophthalmology, Los Angeles, CA, USA.
² University of California Los Angeles, Department of Neurology, Los Angeles, CA, USA.

Abstract

Purpose: This report details the characteristics of a case of bilateral optic neuropathy during treatment with oral lorlatinib for ALK-positive metastatic adenocarcinoma of the lung.

Observations: A 57-year-old woman with metastatic adenocarcinoma of the lung receiving treatment with lorlatinib presented to the ophthalmology urgent care with bilateral loss of vision that had progressed to no light perception over the previous 2 weeks. She was hospitalized for an extensive autoimmune, infectious, neoplastic, and paraneoplastic workup, which revealed enhancement of both optic nerves extending up to the optic chiasm and an area of restricted diffusion in the splenium of the corpus callosum on MRI. Lorlatinib was discontinued by her oncologist and she received treatment with five days of pulse-dose intravenous solumedrol as well as five days of plasmapheresis with gradual improvement in her vision. In follow-up, her vision had improved to 20/40 and 20/30.

Conclusion and importance: There have been few reports describing vision loss associated with lorlatinib, an ALK/ROS1 targeted tyrosine kinase inhibitor used to treat metastatic lung adenocarcinoma. This report details the characteristics of a case of bilateral retrobulbar optic neuropathy as well as the treatment and recovery of such a case. Further exploration is needed in order to improve our understanding of the pathogenesis of this rare but potentially devastating adverse effect.

Keywords: ALK-Positive adenocarcinoma; ALK/ROS1 inhibitor; Lorlatinib associated optic neuropathy; Lorlatinib associated vision loss; Non-small cell lung cancer; Toxic optic neuropathy.

Publication types

Case Reports