In this report, immediate alectinib administration for ALK-altered Lung-CUPs helped the patients’ survival....CK-7 and TTF-1 were positive. ALK overexpression was also observed (Fig. 3g), and alectinib (600 mg/day) was initiated...After alectinib administration, his condition rapidly improved….On June 10 (day 16), the brain metastasis was undetectable by CT, and all other targets had shrunken (Fig. 3h)...MRI indicated that the brain metastasis had decreased to 1 mm in size (Fig. 3i). No adverse events have been observed thus far.