Optimal treatment strategies for this unique subgroup remain undefined.<h4>Case presentation</h4>We describe a 54-year-old woman with stage IV lung adenocarcinoma harboring an EGFR exon 19 deletion, ALK-EML4/KIF5B fusion (V3a/b), and high PD-L1 expression (TPS = 90%). The gene discussed is EML4; the disease is lung adenocarcinoma.