Severe Erosive Esophagitis Induced by Crizotinib Therapy: A Case Report and Review of the Literature
Bibliographic record
Abstract
Crizotinib is an oral tyrosine kinase inhibitor used in the treatment of anaplastic lymphoma kinase (ALK)-positive non-small cell lung cancer (NSCLC). The phase III trial completed prior to approval noted visual disturbances and gastrointestinal symptoms (e.g. nausea, vomiting, and diarrhea) as common adverse events, but no cases of esophagitis were reported. Since then a few case reports have described esophagitis secondary to crizotinib therapy. In all previous reports, esophagitis appears to have developed quite soon (i.e. within 90 days) after initiating or re-initiating crizotinib therapy (see Table 1). We present a woman who developed acute odynophagia and severe erosive esophagitis ten months after beginning crizotinib (see Figure 1). We suspect the provoking factor was a change in her medication administration routine, done to accommodate religious practices during the period of Ramadan. Careful history taking revealed that she had altered her medication schedule as she reported taking her crizotinib earlier in the morning and later in the evening after which she would immediately lay supine, which was much different than her usual routine. Within 2 weeks of this schedule change she began experiencing significant odynophagia. She was on no other medications and biopsies from her endoscopy revealed no signs of candida infection. This unique case suggests that esophagitis related to crizotinib therapy may be directly related to medication administration practices, which can be preventable. Our patient was found to have tumor progression despite therapy so she was started on second line treatment and the crizotinib was not restarted. Her symptoms disappeared within days of stopping the crizotinib and starting twice daily PPI therapy. Our case highlights the importance of patient education surrounding medication administration, which is of utmost importance for cancer patients who require a specific treatment and have few alternative options. Medication administration and any recent changes should always be considered in the differential diagnosis for those presenting with pill esophagitis.Figure 1Table 1: Timing of onset and resolution of symptoms after initiating and discontinuing crizotinib therapy in five previous case reports.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.002 |
| Meta-epidemiology (narrow) | 0.003 | 0.001 |
| Meta-epidemiology (broad) | 0.002 | 0.001 |
| Bibliometrics | 0.006 | 0.006 |
| Science and technology studies | 0.002 | 0.002 |
| Scholarly communication | 0.002 | 0.004 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.005 | 0.003 |
| Insufficient payload (model declined to judge) | 0.003 | 0.002 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".