In general, cancer tumorigenesis relies on the accumulation of mutations and is thought to be fueled by driver mutations that confer a growth advantage.12 Alterations in genes such as EGFR, KRAS, ALK, MET, HER2, ROS1, and RET have been shown to promote non-small cell lung cancer (NSCLC) formation and are currently targetable for cancer treatment.13,14 However, tumor next generation sequencing now allows us to better understand the passenger mutations as well. The gene discussed is ALK; the disease is cancer.