We have a 50yo man with metastatic ALK+ adenocarcinoma of the lung who progressed on crizotinib (was on this for two years) and alectinib (was on this for 4 years). He is now on lorlatinib and wanted to ask about prognosis - we found some studies that suggested a 9 month progression free survival for lorlatinib as a second line or later therapy, but was not sure if there was more helpful information you may know? Of note, his ECOG is about a 3 right now due to weakness/fatigue from repeated hospitalizations for infections though prior to these hospitalizations his performance status was ECOG 1.
With his previous treatment history it seems the two options are TKI or chemotherapy, but I agree with lorlatinib given targetable option and the ECOG of 2-3. In this setting, Solomon et al. Lancet Oncology showed Lorlatinib has ORR 38%, with median PFS 5.4-9.5 months, for patients receiving 2 previous TKIs with or without chemotherapy, I think this is the best data in this setting and also the one which led to approval of Lorlatinib in this setting: https://www.fda.gov/drugs/fda-approves-lorlatinib-second-or-third-line-treatment-alk-positive-metastatic-nsclc.
