A recent case report of a pulmonary ALK-positive LCNEC demonstrated sustained clinical benefit (OS 24+ month) after sequential ALK inhibitors and local therapy, however, the patient progressed after 9 months on Alectinib, and brain metastatic lesions increased again after 4 months of switching to Brigatinib (Kobayashi et al., 2023). This evidence concerns the gene ALK and large cell neuroendocrine carcinoma.