Therefore, the lack of tissue biopsy condemns many patients with rearrangement in ALK to receive chemotherapy instead of ALK-TKIs, with a median overall survival (OS) of ∼12 months instead of ∼50 months from time of diagnosis of metastatic disease as reported by several observational studies using sequential ALK inhibitors [27], [28], [29], [30]. This evidence concerns the gene ALK and metastatic neoplasm.