An 80-year-old Chinese man who had a more than 50-year smoking history and occasionally consumed alcohol was admitted to the local hospital in October 2020 because of hoarseness, shortness of breath after activity, decreased activity endurance, and chest tightness. The patient was otherwise in good health and did not have a history of hypertension, diabetes, coronary heart disease, pneumonia, tuberculosis, or other infectious disease. In 2007, he had undergone cystectomy for bladder cancer, and a percutaneous urine bag was indwelled for a long period after the operation. The patient underwent a physical examination and a series of auxiliary examinations. Enhanced computed tomography (CT) showed a mass in the middle and lower lobes of the right lung (57 x 35 mm), which was considered central lung cancer with obstructive inflammation and segmental atelectasis, and pericardial metastasis. The pathological report of the puncture effusion smear of the lung tumor under the fiberoptic bronchoscope indicated adenocarcinoma. Therefore, the patient was diagnosed with stage IVA non-small cell lung cancer (T3N2M1), ECOG PS 2. Next-generation sequencing (NGS) targeting 1,267 genes identified a rare novel rhabdomyosarcoma 2-associated transcript (RMST)-ALK translocation (R5'UTR: A20) and an ALK-intergenic (A19: intergenic) rearrangement (Figure 1A). The immunohistochemical (IHC) results confirmed that the tumor was ALK fusion positive (Figure 1B). Besides, no EGFR mutations and ROS1 rearrangements were found. Based on the genetic test results, the patient was administered ceritinib treatment (450 mg P.0 QD) in November 2020. After treatment, his CEA declined from 13.38 to 4.2 mug/l, and his CA 125 declined from 465.7 to 54.6 U/ml (Figure 2A). Chest CT demonstrated significantly reduced hydropericardium 1.5 months later, confirming a partial response (Figure 2B). As of July 2022, the patient has retained a partial response to ceritinib treatment.