Remarkably, the tumor harbored seven coexisting driver mutations (ROS1, RET(exon19), RET(exon16), TSC2, ALK, STK11, PTEN) and exhibited a “triple-negative” immunosuppressive profile, which we define here as concurrent negativity for the three established predictors of response to immune checkpoint inhibitors: low tumor mutational burden (TMB-Low), low PD-L1 expression(PD-L1-Low), and microsatellite stable (MSS). The gene discussed is TSC2; the disease is neoplasm.