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Metastatic lung adenocarcinoma — SCE Respiratory MCQ

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HardLung CancerMetastatic lung adenocarcinomaSCE Respiratory

A 64-year-old woman with metastatic non-squamous NSCLC has adenocarcinoma confirmed on biopsy. She is a never-smoker and performance status is 1. Tissue is sufficient for further testing. What is the most appropriate next step before first-line systemic therapy?

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Correct answer: A — Comprehensive molecular profiling including EGFR, ALK, ROS1 and PD-L1 testing

Metastatic non-squamous NSCLC should undergo predictive biomarker testing before choosing first-line systemic therapy because targetable alterations change management. Starting chemotherapy before results can miss a better targeted option in a stable patient. Prophylactic cranial irradiation is relevant to selected SCLC pathways, not routine NSCLC care.

Reference: NICE NG122; NICE genomic testing directory