Can lorlatinib/lorlatinib be used simultaneously with traditional Chinese medicine and is it safe?

Lorlatinib/lorlatinib(Lorlatinib), as a new third-generation ALK and ROS1 tyrosine kinase inhibitor, is widely used in the targeted therapy of non-small cell lung cancer (NSCLC) patients. Current clinical and pharmacological studies have not provided clear systematic evidence as to whether lorlatinib can be used simultaneously with traditional Chinese medicine. As an important part of traditional medicine, traditional Chinese medicine contains a variety of complex ingredients, which may change the pharmacokinetics of lorlatinib by affecting the liver metabolic enzyme system (especially the cytochrome P450 enzyme family).

Lorlatinib is mainly excreted through liver metabolism, especiallyCYP3A4 enzyme system. Therefore, taking it at the same time may cause drug interactions, leading to abnormal drug concentrations, thereby affecting the therapeutic effect or increasing toxic and side effects. Some Chinese medicinal materials, such as ginseng, astragalus, and salvia miltiorrhiza, have been proven to regulate the activity of liver drug enzymes, which may enhance or inhibit the metabolism of lorlatinib, thereby affecting its plasma concentration. In addition, when Chinese medicine and Western medicine are used together, it may trigger unknown immune regulatory reactions or increase the burden on the patient's liver and kidneys.

For safety reasons, it is clinically recommended that patients should avoid combining lorlatinib with traditional Chinese medicine, especially self-administration without evaluation by a doctor or pharmacist. If it is indeed necessary to use traditional Chinese medicine for auxiliary treatment, the attending doctor should be informed in detail and strict monitoring should be carried out, including regular testing of liver function, blood drug concentration and treatment response, to prevent potential adverse events.

With the promotion of integrated traditional Chinese and Western medicine treatment models, more systematic pharmacokinetic and clinical studies are needed in the future to evaluate the safety and effectiveness of lorlatinib combined with traditional Chinese medicine. At present, patients should treat the combination of traditional Chinese medicine and lorlatinib with a scientific and cautious attitude, and avoid adjusting the drug regimen on their own to ensure the continuity of treatment and the stability of the efficacy.

References：https://www.lorbrena.com/