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Progression of disease through crizotinib in a 71-year-old patient with a heavy smoking history who was positive for ALK rearrangement by FISH 5′ deletion, but negative by IHC and NGS. NGS found the tumor to be wildtype for ALK and instead identified a Q61L KRAS mutation. Treatment with crizotinib over 8 weeks yielded no radiologic response, with an increase in the tumor size by 30%.
