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Background  Lung cancer is the leading cause of cancer-related death worldwide. Epidermal growth factor receptor (EGFR) - tyrosine kinase inhibitor (TKI) is used for the patients with  EGFR -mutant lung cancer. Recently, phase III studies in the patients with  EGFR -mutant demonstrated that EGFR-TKI monotherapy improved progression-free survival compared with platinum-doublet chemotherapy. The echinoderm microtubule-associated protein-like 4 ( EML4 )  -  anaplastic lymphoma kinase ( ALK ) fusion oncogene represents one of the newest molecular targets in non-small cell lung cancer (NSCLC). Patients who harbor  EML4-ALK  fusions have been associated with a lack of  EGFR  or  KRAS  mutations.    Case presentation  We report a 39-year-old patient diagnosed as adenocarcinoma harboring  EGFR  mutation and  EML4-ALK  fusion gene. We treated this patient with erlotinib as the third line therapy, but no clinical benefit was obtained.    Conclusion  We experienced a rare case with EGFR mutation and  EML4-ALK . Any clinical benefit using EGFR-TKI was not obtained in our case. The therapeutic choice for the patients with more than one driver mutations is unclear. We needs further understanding of the lung cancer molecular biology and the biomarker infomation.

A case of lung adenocarcinoma harboring EGFR mutation and EML4-ALKfusion gene