How would you approach first-line treatment in metastatic NSCLC for a patient with ALK-EML4 V3a/b variant and MSI-high status?   

Both ALK and MSI-high status were noted on a liquid biopsy since there was not enough tissue available for molecular testing.

Some reports suggest lower sensitivity to ALK inhibitors with variant 3a/b (at least 1st and 2nd generation). Would this change your choice of starting with an ALK TKI?