A next-generation sequencing (NGS) panel revealed the presence of the EML4-ALK fusion variant 3a/b....A second NGS panel did not identify any new ALK resistance mutation but acquiring TP53....Finally, fresh tumor tissue was obtained from a liver biopsy to establish PDOs and drug sensitivity to 8 compounds was tested. The In vitro results demonstrated no activity of lorlatinib but a strong response to crizotinib.