OBJECTIVES:  Between 2-7% of patients with non-small cell lung cancer (NSCLC) have an anaplastic lymphoma kinase (ALK) gene alteration, which suggest the potential for a favorable response to an ALK inhibitor treatment. The objective of this study was to document the current treatment patterns for ALK+ patients in Japan given the recently available and upcoming ALK inhibitor therapies. METHODS:  A multi-country retrospective medical chart-review of NSCLC patients was conducted by cancer-treating physicians in Japan between Q2 2015 and Q1 2016 (N=3,492). Physicians randomly selected patient charts currently on an anti-cancer regimen and abstracted data on patient demographics, disease status, treatment patterns and biomarker status. Only patients who were ALK+ were included in the analyses. RESULTS:  A total of 169 patients were ALK+ and were included; 40.8% were male and the mean age was 63.3 years (SD=13.0). A total of 59.2% were diagnosed in stage IIIb/IV. Slightly more than half of patients had an ECOG score of 0 (56.2%). The most common first-line treatments were crizotinib (26.0%), alectinib (21.3%), and pemetrexed (19.5%). Of the patients who had a second-line treatment (N=96), nearly 90% used an ALK inhibitor either alone (crizotinib = 47.9%; alectinib = 37.5%) or in combination (alectinib+bevacizumab = 4.2%). Among patients who had a third-line treatment (N=32), alectinib (71.9%) and docetaxel (28.1%) were the only treatments used. The four patients who had a fourth-line treatment all used alectinib (100.0%). CONCLUSIONS:  ALK inhibitor treatments have been incorporated quickly into clinical practice in Japan, particularly in second lines and later. Nearly half of ALK+ patients received an ALK inhibitor in first line and over 70% of ALK+ patients received an ALK inhibitor in second, third, and fourth lines. Given the upcoming availability of additional ALK inhibitor treatments, this study provides an important baseline assessment of current treatment patterns.