A 57-year-old Asian man was diagnosed as lung adenocarcinoma with several bone metastasis (non-small cell lung cancer (NSCLC), T1cN0M1c stage IVB, epidermal growth factor receptor (EGFR): negative, anaplastic lymphoma kinase (ALK): negative, programmed death ligand 1 (PDL1) tumor proportion score: 5%, Fig. 1a-c), and he was initially treated with cisplatin and pemetrexed for 4 months, followed by 2nd line pembrolizumab treatment (200 mg/3 weeks). This evidence concerns the gene ALK and neoplasm.