To outline a management strategy for lorlatinib-related psychiatric complications based on a clinical case study and existing literature.
Approach:
Case Presentation: A 46-year-old female patient with metastatic ALK-positive lung cancer developed psychiatric symptoms, including affect lability and derealization, after starting lorlatinib treatment. She was treated with low-dose trazodone after lorlatinib was suspended.
Psychiatric Assessment: The patient underwent a psychiatric evaluation, revealing significant anxiety and sleep disturbances. Trazodone was administered, and psychometric assessments, including HAM-A and ISI, were conducted at baseline and follow-up.
Key Findings:
The patient showed significant improvement in sleep quality and anxiety levels after starting trazodone, as indicated by reductions in HAM-A and ISI scores.
Psychometric scores indicated a return to psychological balance over time, with no reported side effects from trazodone.
Interpretation:
The case suggests that trazodone may be effective in managing psychiatric adverse events associated with lorlatinib treatment.
Limitations:
The study is based on a single case, limiting generalizability.
Long-term effects and optimal dosing of trazodone in this context remain unclear, and there is a lack of long-term follow-up data.
Conclusion:
Trazodone may provide a management strategy for psychiatric symptoms induced by ALK inhibitors like lorlatinib, pending further research.
