Dr Leal on the Updated NCCN Guidelines for Screening for LEMS in SCLC

“The inclusion of tests to identify and diagnose LEMS is an important next step in managing patients with small cell lung cancer who have symptoms that are suspicious for a neurologic paraneoplastic syndrome.”

Ticiana Leal, MD, a professor and director of the Thoracic Medical Oncology Program in the Department of Hematology and Medical Oncology at Emory University School of Medicine, as well as medical director of the Clinical Trials Office at Winship Cancer Institute, discussed the importance of incorporating screening for Lambert-Eaton Myasthenic Syndrome (LEMS) into the evaluation of patients with small cell lung cancer (SCLC) who present with neurologic symptoms suggestive of a paraneoplastic process.

Although LEMS is a relatively rare neurologic paraneoplastic syndrome, it occurs more frequently in association with SCLC than with many other malignancies. The condition can significantly affect patients’ physical functioning and quality of life, making early identification particularly important in the oncology setting, Leal said. Recognizing the syndrome in patients with cancer can be challenging because its symptoms may overlap with those caused by advanced disease or treatment-related fatigue, Leal added.

Patients with LEMS commonly experience progressive muscle weakness, which may manifest as difficulty performing routine activities such as rising from a chair or climbing stairs. In individuals already coping with the burden of lung cancer, these symptoms can easily be attributed to generalized debility or disease progression. As a result, the underlying neurologic syndrome may go unrecognized without targeted screening, Leal explained.

Incorporating testing for LEMS in patients with suspicious neurologic symptoms represents an important step toward improving detection. Increased awareness of this syndrome, particularly through its inclusion in the National Comprehensive Cancer Network’s Clinical Practice Guidelines in Oncology, may help clinicians more readily consider the diagnosis during routine evaluation of patients with SCLC.

Early recognition is critical not only for diagnostic clarity but also for treatment planning. Identifying LEMS can prompt timely referral to neurology and facilitate multidisciplinary management involving both oncologists and neurologists. This collaborative approach allows patients to receive targeted therapies aimed at improving neuromuscular function while they continue to undergo cancer-directed treatment.