39 Y/O F with metastatic LCNEC of lung.Positive for following mutations; STK11, AURKA, AXL, MYC, CCNE1, GNAS, KEAP1, MCL1, RUNX1, TP53.High tumor mutation burden and PD-L1 positive. The gene discussed is KEAP1; the disease is large cell neuroendocrine carcinoma.