39 year old male, ex smoker, who presents with worsening breathing, hemoptysis and chest discomfort. He was found to have mediastinal mass, with endobronchial tumor obstructing the left mainstem bronchus and small brain mets. He underwent rigid bronchoscopy with tumor debulking, argon plasma coagulation and silicone stent placement. Pathology: Mucinous adenocarcinoma with lepidic growth pattern, ALK+. He underwent XRT and initiated on first line palliative Alectinib with good response and evidence of CNS penetration. Silicone stent was removed 7 weeks later.