Special obstacles include the rarity and genetic heterogeneity of the disease due to multiple ALK fusion variants [8], which are further potentiated by its complex management, including highly variable sequences of TKI and local ablative treatments [9], long patient survival of several years [2], limited availability of tissue from small biopsies, and variable ability of next-generation sequencing (NGS) assays to detect gene fusions in tissue or circulating tumor DNA (ctDNA) [10]. This evidence concerns the gene ALK and neoplasm.