ALK and non-small cell lung carcinoma: Interestingly, this observation is similar to data from the multinational PIvOTAL study, in which a TKI was received by up to 11% of patients without a confirmed EGFR mutation/ALK rearrangement in the first-line setting and in 9–56% of patients in the second-line setting [35], and  aligns with studies in Germany (CRISP registry) and the US (Flatiron database) showing that only around three-quarters of patients with advanced or metastatic NSCLC undergo EGFR testing prior to initiation of a first-line TKI [39, 40].