title: Dramatic response to alectinib in a patient of ALK-rearranged lung cancer with poor performance status.
abstract: BACKGROUND
  Lung cancers with anaplastic lymphoma kinase rearrangements are highly sensitive to anaplastic lymphoma kinase tyrosine kinase inhibition, underscoring the notion that such cancers are addicted to anaplastic lymphoma kinase activity. Several anaplastic lymphoma kinase inhibitors have been identified and are being evaluated in clinical trials. However patients with poor performance status (3 or 4) were not involved in these clinical trials, it has been unclear to use anaplastic lymphoma kinase-tyrosine kinase inhibitors for these patients. Here, we report an anaplastic lymphoma kinase-positive non small cell lung cancer patient with performance status 4, who was successfully treated with alectinib.
  
  
  METHODS
  We report on a 52-year-old patient diagnosed as non small cell lung cancer harboring echinoderm microtubule-associated protein-like 4-anaplastic lymphoma kinase fusion gene. His performance status was 4 because of severe respiratory failure. We treated this patient with alectinib as the first line therapy. Dramatic response was obtained and his performance status improved from 4 to 1 without severe adverse events.
  
  
  CONCLUSIONS
  Alectinib is a therapeutic option for the anaplastic lymphoma kinase positive patients with poor performance status.
authors.affiliation: Department of Cardiology, Respiratory Medicine and Nephrology, Hirosaki University Graduate School of Medicine, Zaifu-cho 5, Hirosaki, 036-8562, Japan. xyghx335@gmail.com.
authors.forename: Hisashi
authors.initials: H
authors.lastname: Tanaka
authors.affiliation: Department of Cardiology, Respiratory Medicine and Nephrology, Hirosaki University Graduate School of Medicine, Zaifu-cho 5, Hirosaki, 036-8562, Japan.
authors.forename: Kageaki
authors.initials: K
authors.lastname: Taima
authors.affiliation: Department of Cardiology, Respiratory Medicine and Nephrology, Hirosaki University Graduate School of Medicine, Zaifu-cho 5, Hirosaki, 036-8562, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Morimoto
authors.affiliation: Department of Cardiology, Respiratory Medicine and Nephrology, Hirosaki University Graduate School of Medicine, Zaifu-cho 5, Hirosaki, 036-8562, Japan.
authors.forename: Kunihiko
authors.initials: K
authors.lastname: Nakamura
authors.affiliation: Department of Cardiology, Respiratory Medicine and Nephrology, Hirosaki University Graduate School of Medicine, Zaifu-cho 5, Hirosaki, 036-8562, Japan.
authors.forename: Yoshihito
authors.initials: Y
authors.lastname: Tanaka
authors.affiliation: Department of Laboratory Medicine, Hirosaki University School of Medicine, Honcho 53, Hirosaki, Japan.
authors.forename: Masamichi
authors.initials: M
authors.lastname: Itoga
authors.affiliation: Department of Health Admnistration Center, Hirosaki University, Bunkyo 1, Hirosaki, Japan.
authors.forename: Shingo
authors.initials: S
authors.lastname: Takanashi
authors.affiliation: Department of Cardiology, Respiratory Medicine and Nephrology, Hirosaki University Graduate School of Medicine, Zaifu-cho 5, Hirosaki, 036-8562, Japan.
authors.forename: Ken
authors.initials: K
authors.lastname: Okumura
mesh_terms: D000077548:Anaplastic Lymphoma Kinase; D001999:Bronchoscopy; D002227:Carbazoles / Q000627:therapeutic use*; D002289:Carcinoma, Non-Small-Cell Lung / Q000000981:diagnostic imaging / Q000188:drug therapy; D015321:Gene Rearrangement / Q000235:genetics*; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000235:genetics*; D008297:Male; D008875:Middle Aged; D010880:Piperidines / Q000627:therapeutic use*; D020794:Receptor Protein-Tyrosine Kinases / Q000235:genetics*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D002227:Carbazoles; D010880:Piperidines; C000626173:ALK protein, human; D000077548:Anaplastic Lymphoma Kinase; D020794:Receptor Protein-Tyrosine Kinases; C582670:alectinib
keywords: ALK; Alectinib; Lung cancer; Poor performance status