In contrast, the initial biopsy from the metastatic tumor in the current case showed only ALK rearrangement and wild-type EGFR and KRAS, while re-biopsy from a new metastasis at progression after 8 months of crizotinib treatment revealed the appearance of EGFR and KRAS mutations in addition to an unchanged ALK rearrangement. Here, ALK is linked to metastatic neoplasm.