A 55-year old female presented with chronic cough and 10-lb weight loss PMH: never smoker; no family history of cancer; no known exposure to chemicals or asbestos Chest x-ray showed a 5.0-cm lesion in the left lower lobe with bulky lymphadenopathy Chest CT scan confirmed the presence of a lung mass and enlargement of the right hilar lymph node and bilateral mediastinal lymph nodes EUS-guided biopsy was performed Pathology revealed adenocarcinoma Molecular testing: FISH: negative for ALK translocation NGS: negative for EGFR, ROS1, RET, BRAF, KRAS IHC: PD-L1 expression in 0% of cells PET/CT imaging showed 18F-FDG uptake in the lung mass, right hilar lymph node, mediastinum, and left adrenal gland MRI of the brain was normal ECOG PS, 0 The patient was started on therapy with carboplatin/pemetrexed and bevacizumab The regimen was well tolerated After 6 cycles, the patient had a good response She was continued on bevacizumab After 9 months on therapy, the patient developed cough and weight loss Follow-up imaging revealed multiple new lesions in the left adrenal gland and new liver metastases Patient was started on atezolizumab, planned for 12 months