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ROS1  rearrangement occurs in 1–2% of non‐small cell lung cancer ( NSCLC ) cases. These patients would benefit from treatment with the anaplastic lymphoma kinase inhibitor, crizotinib; however, resistance to crizotinib inevitably develops in such patients despite an initial response. The mechanism of acquired resistance to crizotinib in patients with  NSCLC  with  ROS1  rearrangement has not yet been identified. Herein, we report a case of a 66‐year‐old woman diagnosed with adenocarcinoma.  PCR  revealed no  EGFR  or  ALK  mutations. After the patient underwent several rounds of chemotherapy, crizotinib was administered. The disease explosively progressed six months later. A novel  PIK3CA  gene point mutation (p. L 531 P ) was detected by next generation sequencing. This case is the second report of bypass activation conferred crizotinib resistance in a patient with  NSCLC  with  ROS1 ‐rearrangement, but is the first to confirm that activation of the  mTOR  signaling pathway leads to acquired crizotinib resistance.

thoracic cancer

Patient harboring a novel  PIK3CA  point mutation after acquired resistance to crizotinib in an adenocarcinoma with  ROS1  rearrangement:  A  case report and literature review