• Min Zhang, Ruilin Chen, Suqun Zheng, and Zhen Wang.
• The First Clinical Medical College, Zhejiang Chinese Medicine University, HangZhou, China.
• Medicine (Baltimore). 2023 Mar 17; 102 (11): e33162e33162.

RationaleProto-oncogene-oriented targeted therapy has limited benefits in elderly patients with multiple primary tumors.Patient ConcernsA woman with anaplastic lymphoma kinase-positive lung adenocarcinoma developed acquired resistance after 3 years of targeted therapy with crizotinib.DiagnosesDiagnosis of unexpected subsequent primary gallbladder tumor.InterventionsLenvatinib was administered therapeutically. Meanwhile, next-generation sequencing results before and after crizotinib treatment were analyzed by comparing the tumor-driving mutation genes with bioinformatics methods.OutcomesThe patient died of ascites and liver failure. Furthermore, bypass activation was found to be the main reason for acquired drug resistance for this patient, and the abnormal expression of tumor suppressor genes and senescence-related genes was the likely cause of the second primary tumor.LessonsA bioinformatic comparison of pre- and post-treatment sequencing in elderly oncology patients is of interest.ConclusionsFor diagnosing, precision bioinformatics analysis and repeat biopsy are equally valuable. For therapy, potential therapy such as p53 gene replacement therapy and CAR-T therapy need to be practiced for senescence-related conditions.Copyright © 2023 the Author(s). Published by Wolters Kluwer Health, Inc.

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