The incidence of SCLC transformation in ALK disease is very rare (0.8%, 2/263); however, the cases seem to increase moving from first to third generation ALK-Is: no cases were identified after crizotinib progression (0/95); 0.8% were identified after second generation ALK-I (1/130); and 2.6% were identified after lorlatinib treatment (2/38) [96]. Here, ALK is linked to small cell lung carcinoma.