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Metastatic squamous NSCLC — SCE Respiratory MCQ

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HardLung CancerMetastatic squamous NSCLCSCE Respiratory

A 73-year-old man with stage IV squamous NSCLC has PD-L1 expression of 80%, no targetable mutations and ECOG performance status 1. He has no autoimmune disease. What is the most appropriate management?

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Correct answer: B — First-line immune checkpoint inhibitor-based systemic therapy

The best answer is “First-line immune checkpoint inhibitor-based systemic therapy”. First-line immune checkpoint inhibitor-based systemic therapy is the recommended next management step after the clinical severity, prior treatment and contraindications in the stem are taken into account. The alternatives are either insufficient, unnecessarily invasive, or reserved for a different physiological or risk profile. The remaining choices—“Curative lobectomy, with clinical reassessment”, “Prophylactic cranial irradiation, within a respiratory pathway”, “Isoniazid prophylaxis before cancer therapy as sole treatment”, “Observation until symptomatic progression”—are credible in related respiratory presentations, but each addresses a different diagnostic, staging or management decision and does not fit the decisive findings and pathway position in this stem.

Reference: NICE NG122 lung cancer: diagnosis and management: https://www.nice.org.uk/guidance/ng122/chapter/Recommendations