Second-generation inhibitor alectinib has been granted a breakthrough therapy designation by the FDA due to its effectiveness for most ALK mutations, stronger targeting ability and greater advantages in intracranial disease control.1,2 ALEX studies showed that median progression-free survival times were 34.8 months with alectinib and 10.9 months with crizotinib in untreated ALK+ NSCLC.3 Currently, there are no case reports of alectinib for treating ALK+ LBCL. The gene discussed is ALK; the disease is non-small cell lung carcinoma.