Analysis of the left fronto-median metastasis that developed under treatment with entrectinib via the INFORM registry at the DKFZ revealed the already known EML4:NTRK3 fusion without resistance mutation, the homozygous CDKN2A/B deletion already detected in the primary tumor, an INSR mutation (p. D601Y, VAF = 0.4), an NF2 splicing mutation (c.522 + 1G > C, VAF = 0.66, resulting in exon-skipping), and AURKC, IGF1 and TGFB3 mRNA overexpression. Here, INSR is linked to neoplasm.