We report a case of a 70-year-old female with atypical carcinoid with metastasis to the liver and axial skeleton…a circulating tumor DNA (ctDNA) sample was obtained the same day which revealed an EML4-ALK fusion gene...the disease progression was demonstrated in the liver and the patient was switched to the third-generation ALK inhibitor lorlatinib....the patient has continued to demonstrate sustained clinical, radiographic, and biochemical responses while on lorlatnib for two years.