ALK and non-small cell lung carcinoma: Prospective evidence to support this strategy is available only for asymptomatic BM from EGFR+/ALK+ NSCLC, and only with first-line use of the newer TKI osimertinib, alectinib, brigatinib, or lorlatinib, which show very good intracranial efficacy.8, 9, 10, 11 For symptomatic BM, surgery and/or radiotherapy are generally preferable in order to quickly reduce mass effects to the healthy brain and alleviate neurological symptoms.6