• Liang Dong, Jingwen Xia, Jing Zhang, Yuanyuan Zhang, Ning Zhu, Peng Zhang, Youzhi Zhang, Xiujuan Zhang, and Shengqing Li.
• Department of Pulmonary and Critical Care Medicine, Huashan Hospital, Fudan University, #12, Urumqi middle Road, Shanghai, 200040, China.
• BMC Pulm Med. 2018 Jan 23; 18 (1): 13.

BackgroundCrizotinib is recommended as first-line therapy in ROS1-driven lung adenocarcinoma. However, the optimal first-line therapy for this subgroup of lung cancer is controversial according to the available clinical data.Case PresentationHere, we describe a 57-year-old man who was diagnosed with stage IIIB lung adenocarcinoma and EGFR/KRAS/ALK-negative tumors. The patient received six cycles of pemetrexed plus cisplatin as first-line therapy and then pemetrexed as maintenance treatment, with a progression-free survival (PFS) of 42 months. The patient relapsed and underwent re-biopsy. EZR-ROS1 fusion mutation was detected by next-generation sequencing (NGS). The patient was prescribed crizotinib as second-line therapy and achieved a PFS of 6 months. After disease progression, lorlatinib was administered as third-line therapy, with a favorable response.ConclusionsProlonged PFS in patients receiving pemetrexed chemotherapy might be related to the EZR-ROS1 fusion mutation. Lorlatinib is an optimal choice in patients showing crizotinib resistance.

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