We present the case of a 26-year-old man who was diagnosed with ALK-positive extensive-stage SCLC...After 2 cycles of Alectinib, the CT scan showed a partial response. However, after 9 cycles of treatment, a metastatic lesion enlarged and a new brain lesion appeared....NGS analysis of a series of liquid biopsies revealed a new mutation, ALK p.G1202R, which resulted in resistance to Alectinib... The patient is currently receiving Anlotinib in combination with CPT-11 and is stable with an OS of more than 18 months.