This report is the first to show the efficacy of alectinib as an initial ALK-TKI in a group of nonlung solid tumors, and the first to report the clinical benefit of alectinib in rare cancer types such as ALK-positive histiocytosis, histiocytic sarcoma, and parotid gland adenocarcinoma with CTNNA-ALK, in addition to tumors with known fusion types such as IMT with CLTC-ALK fusion. The gene discussed is ALK; the disease is cancer.