title: Effective Crizotinib schedule for an elderly patient with ALK rearranged non-small-cell lung cancer: a case report.
abstract: BACKGROUND
  Non-small-cell lung cancers (NSCLCs) harboring translocations in anaplastic lymphoma kinase (ALK) are highly sensitive to small-molecule ALK kinase inhibitors, such as crizotinib.
  
  
  METHODS
  We describe a case of post-operative local recurrence of lung adenocarcinoma in an 81 year-old male. He underwent radiation and received chemotherapy with docetaxel, but neither treatment regimen was effective. Following identification of ALK rearrangements, crizotinib treatment was initiated. After treatment with crizotinib for 5 days, adverse events including acute renal failure (grade 2/CTCAE ver4.0) and congestive heart failure (grade 3) occurred. Crizotinib modified treatment was required. Half dose of crizotinib treatment could not control tumor progression. Ultimately, crizotinib was administrated at a dose of 250 mg twice daily every 3 day dosing for 13 months with maintenance of the anti-tumor effect.
  
  
  CONCLUSIONS
  This is the first case report that skip schedule was more effective than dose reduction daily in crizotinib administration for ALK rearranged NSCLC patient with severe adverse events.
authors.affiliation: Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8602, Japan. ayafujita@nms.ac.jp.
authors.forename: Aya
authors.initials: A
authors.lastname: Fukuizumi
authors.affiliation: Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8602, Japan. a-miyanaga@nms.ac.jp.
authors.forename: Akihiko
authors.initials: A
authors.lastname: Miyanaga
authors.affiliation: Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8602, Japan. mseike@nms.ac.jp.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Seike
authors.affiliation: Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8602, Japan. y-kato@nms.ac.jp.
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Kato
authors.affiliation: Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8602, Japan. snakamichi@nms.ac.jp.
authors.forename: Shinji
authors.initials: S
authors.lastname: Nakamichi
authors.affiliation: Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8602, Japan. s9048@nms.ac.jp.
authors.forename: Kumi
authors.initials: K
authors.lastname: Chubachi
authors.affiliation: Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8602, Japan. s7062@nms.ac.jp.
authors.forename: Masaru
authors.initials: M
authors.lastname: Matsumoto
authors.affiliation: Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8602, Japan. r-noro@nms.ac.jp.
authors.forename: Rintaro
authors.initials: R
authors.lastname: Noro
authors.affiliation: Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8602, Japan. yminegis@nms.ac.jp.
authors.forename: Yuji
authors.initials: Y
authors.lastname: Minegishi
authors.affiliation: Department of Analytic Human Pathology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan. s-hemmi@nms.ac.jp.
authors.forename: Shinobu
authors.initials: S
authors.lastname: Kunugi
authors.affiliation: Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8602, Japan. kkubota@nms.ac.jp.
authors.forename: Kaoru
authors.initials: K
authors.lastname: Kubota
authors.affiliation: Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8602, Japan. agemma@nms.ac.jp.
authors.forename: Akihiko
authors.initials: A
authors.lastname: Gemma
mesh_terms: D000369:Aged, 80 and over; D000077548:Anaplastic Lymphoma Kinase; D002272:Carcinoembryonic Antigen / Q000097:blood; D002289:Carcinoma, Non-Small-Cell Lung / Q000097:blood / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000473:pathology; D000077547:Crizotinib; D004334:Drug Administration Schedule; D015321:Gene Rearrangement; D006801:Humans; D008175:Lung Neoplasms / Q000097:blood / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000473:pathology; D008297:Male; D020097:Natriuretic Peptide, Brain / Q000097:blood; D011720:Pyrazoles / Q000627:therapeutic use*; D011725:Pyridines / Q000627:therapeutic use*; D011859:Radiography; D020794:Receptor Protein-Tyrosine Kinases / Q000378:metabolism*; D016896:Treatment Outcome
chemical_list: D002272:Carcinoembryonic Antigen; D011720:Pyrazoles; D011725:Pyridines; D020097:Natriuretic Peptide, Brain; D000077547:Crizotinib; C000626173:ALK protein, human; D000077548:Anaplastic Lymphoma Kinase; D020794:Receptor Protein-Tyrosine Kinases