CASE PRESENTATION: Twelve patients with ALK rearranged NSCLC were retrospectively evaluated as a single institution experience. The median age was 56 (range 29-80) years, and 7 of 12 (58.8%) patients were male; furthermore, all the patients had adenocarcinoma. Although our experience is limited to a small number of patients with ALK rearranged NSCLC, all patients were symptomatic, and 5 of 12 (42%) had poor performance status (ECOG performance status 2 or 3) at the diagnosis. More than half of the total number of patients (7 of 12; 58.8％) experienced an oncology emergency. The time to treatment failure after crizotinib administration in patients with a poor performance status was significantly shorter than that in patients with a good performance status. [1.0 months (95%CI, 1.0-2.0) in vs 12 months (95%CI, 7.0-not determined) respectvely, p=0.0006] The overall survival was significantly longer in patients with a good performance status as compared to that in patients with a poor performance status [6.5 months (95%CI, 6-not determined) vs, 49 months (95%CI, 16-59), respectively; p=0.0076].