Lorlatinib-associated sensorineural deafness in a non-small cell lung cancer patient with ALK-fusion: a Case Report

In the era of precision targeted therapy, anaplastic lymphoma kinase (ALK) tyrosine kinase inhibitors (TKIs) have significantly improved survival outcomes for patients with ALK -positive non-small cell lung cancer (NSCLC). The third-generation ALK inhibitor lorlatinib, characterized by superior antitumor activity, a broader spectrum of ALK mutation sites and enhanced central nervous system (CNS) penetrability, has yielded breakthrough clinical benefits. However, lorlatinib has a distinct adverse event profile, with edema, dyslipidemia, central and peripheral nervous system toxicities, posing key clinical management challenges. Herein, we report the first case of an ALK -fusion NSCLC patient who developed peripheral neuropathy, dysarthria, and sensorineural deafness following lorlatinib treatment. While dysarthria and peripheral neuropathy have been previously documented, sensorineural deafness is extremely rare, and no prior reports describe the concurrent and persistent onset of all three symptoms, underscoring the need for enhanced toxicity monitoring and patient education.