Proactive Care in ALK+ NSCLC: AE Counseling, Monitoring, and Management
Panelists discuss how proactive monitoring for ALK inhibitor adverse effects through regular lipid panels, liver function tests, and patient education about red flag symptoms such as bradycardia or cognitive changes enables early intervention and successful dose management.
Comprehensive patient counseling and proactive monitoring form the foundation of successful ALK inhibitor therapy management, requiring structured approaches to education, adverse event prevention, and early intervention strategies. Patient education protocols must address the distinct adverse effect profiles of different ALK inhibitors, with lorlatinib requiring particular attention to cardiovascular monitoring, including blood pressure and lipid management, central nervous system (CNS) toxicity surveillance, and dermatologic care. Baseline assessment and optimization of cardiovascular risk factors, including blood pressure control and lipid management, are essential before initiating lorlatinib therapy.
Monitoring protocols include regular assessment of cardiovascular parameters, with appropriate interventions such as ACE inhibitors or statins as clinically indicated, dermatologic surveillance with moisturizing and topical steroid protocols, and gastrointestinal symptom management, including constipation prevention through adequate fluid and fiber intake. CNS toxicity monitoring represents a critical component of lorlatinib management, requiring regular assessment of cognitive function, speech patterns, and energy levels, with patient education about the importance of reporting subtle changes that may indicate developing neurotoxicity.
Red flag symptoms requiring immediate reporting include bradycardia that may progress to requiring cardiac pacing, significant weight gain and joint pain that affect quality of life, and any CNS symptoms, including cognitive changes or speech difficulties. Health care teams must implement systematic approaches to capture these symptoms through regular questioning, as patients may not spontaneously report gradual changes or may attribute symptoms to other causes. Laboratory monitoring, including liver function tests, lipid panels, and creatinine assessment, should be performed at regular intervals, with more frequent monitoring during treatment initiation. The collaborative approach between physicians, advanced practitioners, nurses, and support staff ensures comprehensive patient surveillance and timely intervention when adverse events develop.
