Furthermore, targeted therapy, such as anaplastic lymphoma kinase (ALK) inhibitors, induces a complex network of secretory signals, promoting the survival of cancer cells sensitive to the drug.[2] A study based on Surveillance, Epidemiology, and End Results database showed that lung cancer patients with a duration >120 months had an increased risk of secondary primary gallbladder cancer.[3] Owing to tumor heterogeneity, there may be multiple mechanisms of treatment resistance and the development of multiple primary tumors in the same patient. This evidence concerns the gene ALK and lung carcinoma.