Later, immunotherapy moved into the 1L setting: pembrolizumab received market access approval from AIFA at the national level in May 2017 for both 1L metastatic NSCLC (monotherapy for metastatic NSCLC with PD-L1 ≥50% and without EGFR- or ALK-positive tumor mutations) and 2L treatment (monotherapy for locally advanced or metastatic NSCLC with PD-L1 ≥1% who have received at least one prior chemotherapy) [9]. Here, ALK is linked to neoplasm.