Olanzapine enabled rechallenge after lorlatinib‐induced psychosis: A case report
Abstract Background Lorlatinib is a third‐generation tyrosine kinase inhibitor for anaplastic lymphoma kinase (ALK)‐positive non‐small cell lung cancer (NSCLC). While it has a high intracranial lesion control rate, it can also cause central nervous system complications, including psychotic symptoms....
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| Format: | Article |
| Language: | English |
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Wiley
2025-06-01
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| Series: | PCN Reports |
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| Online Access: | https://doi.org/10.1002/pcn5.70091 |
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| author | Akiyoshi Yokode Masaki Fujiwara Yuko Nakamura Kadoaki Ohashi Shinji Sakamoto Manabu Takaki |
| author_facet | Akiyoshi Yokode Masaki Fujiwara Yuko Nakamura Kadoaki Ohashi Shinji Sakamoto Manabu Takaki |
| author_sort | Akiyoshi Yokode |
| collection | DOAJ |
| description | Abstract Background Lorlatinib is a third‐generation tyrosine kinase inhibitor for anaplastic lymphoma kinase (ALK)‐positive non‐small cell lung cancer (NSCLC). While it has a high intracranial lesion control rate, it can also cause central nervous system complications, including psychotic symptoms. We present a case of lorlatinib‐induced psychosis successfully managed with olanzapine, enabling lorlatinib rechallenge. Case Presentation A 32‐year‐old woman with ALK‐positive NSCLC and brain metastases was started on lorlatinib. After 18 months, she developed hallucinations and delusions. Despite treatment with risperidone, her psychotic symptoms persisted, leading to hospitalization. Her symptoms resolved upon lorlatinib discontinuation while risperidone was continued. Given the critical role of lorlatinib in controlling brain metastases, rechallenge was considered. To mitigate concerns regarding drug interactions, risperidone was replaced with olanzapine. Following lorlatinib rechallenge with olanzapine, no recurrence of psychiatric symptoms was observed, allowing continued lorlatinib treatment. Additionally, no progression of lung cancer was noted. Conclusion Lorlatinib is an essential drug for controlling brain metastases in ALK‐positive NSCLC. However, it can induce psychotic symptoms. When psychiatrists are involved in managing adverse effects during cancer treatment, close collaboration among oncologists, psychiatrists, and patients is essential. |
| format | Article |
| id | doaj-art-978e088b9b1c4503a198343db4332330 |
| institution | Kabale University |
| issn | 2769-2558 |
| language | English |
| publishDate | 2025-06-01 |
| publisher | Wiley |
| record_format | Article |
| series | PCN Reports |
| spelling | doaj-art-978e088b9b1c4503a198343db43323302025-08-20T03:27:57ZengWileyPCN Reports2769-25582025-06-0142n/an/a10.1002/pcn5.70091Olanzapine enabled rechallenge after lorlatinib‐induced psychosis: A case reportAkiyoshi Yokode0Masaki Fujiwara1Yuko Nakamura2Kadoaki Ohashi3Shinji Sakamoto4Manabu Takaki5Department of Neuropsychiatry Okayama University Hospital Okayama JapanDepartment of Neuropsychiatry Okayama University Hospital Okayama JapanDepartment of Neuropsychiatry Okayama University Hospital Okayama JapanDepartment of Respiratory Medicine Okayama University Hospital Okayama JapanDepartment of Neuropsychiatry Okayama University Hospital Okayama JapanDepartment of Neuropsychiatry Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Okayama JapanAbstract Background Lorlatinib is a third‐generation tyrosine kinase inhibitor for anaplastic lymphoma kinase (ALK)‐positive non‐small cell lung cancer (NSCLC). While it has a high intracranial lesion control rate, it can also cause central nervous system complications, including psychotic symptoms. We present a case of lorlatinib‐induced psychosis successfully managed with olanzapine, enabling lorlatinib rechallenge. Case Presentation A 32‐year‐old woman with ALK‐positive NSCLC and brain metastases was started on lorlatinib. After 18 months, she developed hallucinations and delusions. Despite treatment with risperidone, her psychotic symptoms persisted, leading to hospitalization. Her symptoms resolved upon lorlatinib discontinuation while risperidone was continued. Given the critical role of lorlatinib in controlling brain metastases, rechallenge was considered. To mitigate concerns regarding drug interactions, risperidone was replaced with olanzapine. Following lorlatinib rechallenge with olanzapine, no recurrence of psychiatric symptoms was observed, allowing continued lorlatinib treatment. Additionally, no progression of lung cancer was noted. Conclusion Lorlatinib is an essential drug for controlling brain metastases in ALK‐positive NSCLC. However, it can induce psychotic symptoms. When psychiatrists are involved in managing adverse effects during cancer treatment, close collaboration among oncologists, psychiatrists, and patients is essential.https://doi.org/10.1002/pcn5.70091psycho‐oncologylorlatiniblung cancermedication‐induced psychosis |
| spellingShingle | Akiyoshi Yokode Masaki Fujiwara Yuko Nakamura Kadoaki Ohashi Shinji Sakamoto Manabu Takaki Olanzapine enabled rechallenge after lorlatinib‐induced psychosis: A case report PCN Reports psycho‐oncology lorlatinib lung cancer medication‐induced psychosis |
| title | Olanzapine enabled rechallenge after lorlatinib‐induced psychosis: A case report |
| title_full | Olanzapine enabled rechallenge after lorlatinib‐induced psychosis: A case report |
| title_fullStr | Olanzapine enabled rechallenge after lorlatinib‐induced psychosis: A case report |
| title_full_unstemmed | Olanzapine enabled rechallenge after lorlatinib‐induced psychosis: A case report |
| title_short | Olanzapine enabled rechallenge after lorlatinib‐induced psychosis: A case report |
| title_sort | olanzapine enabled rechallenge after lorlatinib induced psychosis a case report |
| topic | psycho‐oncology lorlatinib lung cancer medication‐induced psychosis |
| url | https://doi.org/10.1002/pcn5.70091 |
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