Abstract
Background. Although several guidelines recommend first-line treatment with crizotinib for echinoderm microtubule-associated protein-like 4-anaplastic lymphoma kinase (EML4-ALK)-positive lung cancer, there have been few reports of the use of first-line treatment with crizotinib in elderly patients or patients with a poor performance status. Case. A 77-year-old female presented with left femoral pain. Magnetic resonance imaging (MRI) of the pelvis and lower bone showed a left femoral mass. Bronchofiberscopy was performed, and the patient was subsequently diagnosed with adenocarcinoma in the lower lobe of the right lung. Immunohistochemical staining and fluorescence in situ hybridization revealed that the tumor was harboring the EML4-ALK fusion oncogene. The patient was elderly and had a poor performance status (PS 3); therefore, the administration of cytotoxic chemotherapy was inappropriate, and crizotinib was chosen as the first-line chemotherapy. The dose of crizotinib had to be reduced from 250 mg twice daily to 200 mg twice daily with five days on/two days off each week due to nausea and prolonged QT syndrome. The crizotinib treatment led to a tumor response and an improvement in the patient's performance status, which has been sustained. Conclusions. In the present case, crizotinib demonstrated effectiveness and tolerability in an elderly patient with EML4-ALK-positive lung cancer and a poor performance status.
