We present a 25-year-old African American woman who was diagnosed with metastatic ALK+ lung adenocarcinoma at 15 weeks of gestation. Treatment with alectinib was initiated at 18 weeks' gestation with resultant radiological treatment response.

To our knowledge, this is the first case discussing the treatment of ALK-rearranged IMA of the lung with neoadjuvant alectinib. The patient achieved both radiologic and pathologic regressions after three cycles of oral alectinib, and so far, no adverse reactions have been found. The therapeutic effect of alectinib is remarkable. This case proves that in patients with advanced ALK-rearranged lung adenocarcinoma, neoadjuvant alectinib can achieve favorable therapeutic effects, which can provide a reference for clinical treatment of patients.