Here, we report a patient with NSCLC harboring a novel HIP1-ALK fusion variant (H30; A20). This patient and another patient with EML4-ALK variant 3a/b initially responded sequentially to crizotinib and then alectinib, a next-generation ALK inhibitor, but developed acquired resistance to alectinib with the presence of a mutation in amino acid residue 1171 (I1171N and I1171S respectively)...She had a partial response (PR) although on crizotinib but developed progression after 5 months. She was then enrolled onto the phase 1 dose escalation portion of the alectinib trial...