Metastatic non-small cell lung cancer (NSCLC) patients who have PD-L1 ≥ 50% and negative for other actionable molecular markers (epidermal growth factor receptor mutation, anaplastic lymphoma kinase rearrangement and others) are offered first line ICI instead of chemotherapy after a randomized controlled trial demonstrated superior overall survival (OS) over chemotherapy [30]. The gene discussed is ALK; the disease is non-small cell lung carcinoma.