In advanced NSCLC patients with PDL1 ≥ 50% and no EGFR and ALK aberrant, those with a no to light (≤40 pack years) smoking history and more organs involved with metastatic disease on the pretreatment CT are more likely to progress when receiving the current standard first-line treatment—pembrolizumab monotherapy. The gene discussed is ALK; the disease is metastatic neoplasm.