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JAMA Oncology Clinical Challenge
October 1, 2020

Progressive Dry Cough in a Patient With ROS1-Rearranged Lung Adenocarcinoma Undergoing Crizotinib Therapy

Author Affiliations
  • 1Division of Surgical Pathology, Department of Pathology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
  • 2Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
  • 3Institute of Clinical Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
  • 4Department of Biochemistry and Molecular Biology, College of Medicine, National Cheng Kung University, Tainan, Taiwan
JAMA Oncol. Published online October 1, 2020. doi:10.1001/jamaoncol.2020.2809

A 69-year-old man with a smoking history and complaints of back pain and cough for 2 weeks was found to have a right lung mass on chest radiography results. A chest computed tomography (CT) scan showed a right upper lobe lung mass with multiple lymphadenopathies (N3), and bone scan and brain magnetic resonance imaging results showed multiple metastatic foci. A biopsy was performed, and the pathologic report showed a poorly differentiated lung adenocarcinoma with ROS1 rearrangement identified by immunohistochemical staining (clone: D4D6; H-score: 280) and further confirmative fluorescence in situ hybridization. The patient received ceritinib, 450 mg/day, and his tumor and brain and bone metastatic lesions subsequently decreased in size. The ceritinib was then shifted to crizotinib, 500 mg/day, when the reimbursement of crizotinib as a first-line therapy was approved by Taiwan's National Health Insurance system.

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    1 Comment for this article
    SLR?
    matthew painschab |
    Please define this critically important acronym.
    CONFLICT OF INTEREST: None Reported
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