Here, we report the first case of ALK-rearranged lung adenocarcinoma with major pathological response in resected specimens after treatment with alectinib, which may provide a pathological rationale for its greater clinical efficacy for advanced patients and may warrant clinical trials of adjuvant treatment of alectinib for resectable ALK-rearranged NSCLC patients. This evidence concerns the gene ALK and non-small cell lung carcinoma.