The original specimen was identified as poorly differentiated ALK-fusion ADC.[65] The author proposed that the tumor morphological changes were a result of alectinib treatment rather than an independent de novo cancer.[65] This finding aligns with previous studies reporting SCLC transformation in ALK-fusion NSCLC patients after treatment with ALK inhibitors.[65,66] Interestingly, a retrospective study revealed a longer median time to SCLC transformation in the non-EGFR mutation group compared to the EGFR-mutant group (26 months versus 16 months). This evidence concerns the gene ALK and neoplasm.