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━━ Background. The feasibility of crizotinib treatment in nonagenarian patients with lung cancer exhibiting rearrangement of the echinoderm microtubuleassociated protein-like 4-anaplastic lymphoma kinase (EML4-ALK) fusion gene is not well known. Case. A 92year-old woman with chronic renal dysfunction presented with a low-grade fever and dry cough lasting for one month upon admission to the Department of Internal Medicine at our hospital. A chest radiograph showed left total atelectasis, and computed tomography (CT) demonstrated a left hilar mass totally obstructing the main bronchus. Multiple low-density areas were also identified in the liver, and fiberoptic gastroscopy disclosed hemorrhagic gastritis. A needle biopsy of the liver revealed adenocarcinoma with immunohistochemical staining positive for TTF-1. Therefore, left lung cancer with multiple liver metastases was diagnosed. Rearrangement of the EML4-ALK fusion gene was also detected on both immunohistochemical staining and a FISH assay of the liver specimen. Hence, treatment with crizotinib was started at a dose of 400 mg per day. On day 5, the patient experienced a drastic improvement in dyspnea, and a chest radiograph and CT scan showed complete recanalization of left main bronchus. In addition, the liver tumor had significantly decreased in size on CT. The patient did not require further oxygen inhalation; however, she refused to take crizotinib on day 8 due to repeated diarrhea and constipation resulting in frequent abdominal pain. Unfortunately, a fever developed six days after crizotinib cessation, and the patient suddenly died two days later of massive hematemesis. An autopsy was not performed, and the exact cause of hematemesis was unknown. Conclusions. Crizotinib has a substantial anticancer effect, even in nonagenarians. To the best of our knowledge, the current patient is the oldest to exhibit a dramatic and rapid response to crizotinib. The relationship between sudden death due to hematemesis and the administration of crizotinib is unknown. The patient’s condition in this case may have simply involved the acute exacerbation of preexisting hemorrhagic gastritis, although the rapid deterioration of undetected intestinal metastatic lesions is also possible. (JJLC. 2014;54:951-954)

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Hematemesis Following Rapid Recanalization of the Obstructed Left Main Bronchuswith Crizotinib in a 92-year-old Patient with EML4-ALK Rearrangement-positive Lung Adenocarcinoma