Severe ulcerative esophagitis and colitis induced by crizotinib therapy: A case report

Abstract The expression of anaplastic lymphoma kinase (ALK), a target of tyrosine kinase is altered in several kinds of cancer, including in non‐small cell lung cancer (NSCLC). For this reason, the use of crizotinib to treat locally advanced or metastatic ALK‐positive NSCLC was approved by the US Food and Drug Administration in 2011. The reported adverse events during clinical trials with crizotinib included esophageal disorders in 11% of the patients, although none of them experienced severe events. Drug‐induced esophagitis or more severe ulcerations are considerably rare according to the available case reports. We report a patient who presented with severe esophageal ulcers after 2‐year treatment with crizotinib for metastatic, ALK‐positive NSCLC. These clinical conditions improved after education on proper eating habits and an additional prescription of a proton pump inhibitor. Several months later, the patient developed colitis with severe diarrhea, which was successfully controlled with mesalazine without reductions in the dosage of crizotinib. To the best of our knowledge, this is the first published case of successfully treated, consecutive esophageal and colonic ulcers related to crizotinib use. Crizotinib is a widely used targeted therapy for locally advanced or metastatic ALK‐positive NSCLC, and clinicians should keep in mind its severe drug‐related adverse effects such as esophagitis and colitis. Treatment with mesalazine, esomeprazole, and slightly decreasing the dose of crizotinib to 200 mg twice daily will be effective.