What first line treatment would you choose for stage IV adenocarcinoma of lung with ALK gene rearrangement and PD-L1 TPS 95%?  

If you follow FDA labels, you cannot use first line pembrolizumab on a patient with EGFR or ALK aberration unless they have failed targeted therapy first. So that is problem # 1, insurance may deny use of first line immunotherapy in a patient with ALK (+) NSCLC. I am not aware of a head to head comp...