The patient harbored seven coexisting driver mutations [ROS1, RET(exon16,exon19), TSC2, ALK, STK11, PTEN] and exhibited triple-negative immunosuppressive biomarkers: low PD-L1 expression (TPS 3%), low tumor mutational burden (TMB, 11mut/Mb), and microsatellite stable (MSS) status. This evidence concerns the gene PTEN and neoplasm.