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patients in concurrent group developed grade 2 or 3 pneumonitis at some point during crizotinib therapy. Time to onset of pneumonitis ranged from 14 days to 61 days in concurrent group. Imaging analysis was strongly consistent with lung parenchyma changes in the irradiated lung volume receiving a total dose of 15-38 Gy. Pulmonary toxicity was manageable; however, interruption of crizotinib therapy was not necessary. Three (37.5%) experienced development of a grade 2 pneumonitis in sequential group. Pneumonitis in irradiated lungs did not aggravate after crizotinib therapy in sequential group. Conclusion: In conclusion, this is, to our knowledge, the first report of lung toxicity after treatment with crizotinib and TRT. We observed a high incidence of pulmonary toxicity when crizotinib and concurrent TRT were administered in patients with ALK-positive NSCLC. Careful consideration and monitoring for pneumonitis may be warranted in patients treated with crizotinib in concurrent with TRT. In addition, using other schedules (e.g., sequential as opposed to concurrent administration) may be safe and optimal strategies.

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