The MYSTIC trial (NCT02453282), conducted among mNSCLC patients with no sensitizing epidermal growth factor receptor (EGFR) mutation or anaplastic lymphoma kinase (ALK) genomic tumor aberrations, did not meet its primary end points of improved OS or PFS for T+D vs. CT in patients with over 25% tumor proportion score, but identified a tumor mutational burden from blood (bTMB) threshold of 20 mut/Mb for optimal OS benefit (Rizvi et al., 2020). This evidence concerns the gene ALK and neoplasm.