Lung cancer is the second most common cancer worldwide. Non-small cell lung cancer (NSCLC) with anaplastic lymphoma kinase ( ALK ) gene rearrangements constitutes 3-5%. Crizotinib was approved for the first-line therapy of advanced ALK-positive NSCLC patients. We present a female patient with advanced ALK-positive NSCLC who was kept on crizotinib as first-line therapy and showed progression-free survival (PFS) of 48 months despite the data suggesting that the majority of patients on crizotinib show relapse within 1 year. Further studies should focus on the molecular and biological factors and the possible effect of the long-term use of this drug. J Med Cases. 2021;12(9):366-368 doi: https://doi.org/10.14740/jmc3743