LCNEC — SCE Medical Oncology MCQ

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HardLung CancerLCNECSCE Medical Oncology

A 65-year-old man with large cell neuroendocrine carcinoma (LCNEC) of the lung presents with stage IV disease. ECOG PS 1. What is the recommended first-line systemic therapy?

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Correct answer: B — Platinum-etoposide (as for SCLC) or platinum-pemetrexed/gemcitabine (as for NSCLC)

LCNEC is a rare high-grade neuroendocrine lung cancer with features intermediate between SCLC and NSCLC. No specific randomised trial exists for LCNEC. Treatment follows either SCLC-like protocols (platinum-etoposide) or NSCLC-like protocols (platinum-pemetrexed/gemcitabine) — the choice often depends on molecular profiling (SCLC-like = RB1/TP53 loss; NSCLC-like = STK11/KRAS/KEAP1 mutations). Retrospective data suggests similar outcomes with either approach.

Reference: ESMO 2024 Lung Neuroendocrine Tumour Guidelines; NICE NG122