TP53 mutation was associated with shorter OS in all three fusions (mOS [TP53 mt+/mt-] ALK; 35.7 vs. 108.8, p < 0.01, ROS1; 26.4 vs. 47.4, p = 0.06, RET; 28.9 vs. 76.1 months, p = 0.05), shorter PFS with first line alectinib in ALK (mPFS [TP53 mt+/mt-] 11.0 vs. 38.4 months, hazard ratio [HR] 2.5 [95% CI, 1.5-4.2], p < 0.01) and shorter PFS with initial crizotinib in ROS1 (mPFS [TP53 mt+/mt-] 5.8 vs. 25.2 months, HR 2.6 [95% CI, 1.3-4.8], p < 0.01).