Despite a small percentage of these patients, the issue of patients with a positive mutation in the anaplastic lymphoma kinase (ALK) gene is highly debated. Alectinib demonstrated a statistically significant prolongation of progression-free time and an excellent therapeutic and preventive effect in the central nervous system in phase III ALEX, J-ALEX and ALUR studies.1-3 At the time of writing, alectinib is fully reimbursed in first-line treatment even after crizotinib failure.4