Dr Sands on Key Considerations for the Identification of LEMS in SCLC

" This is a space where it's important to identify patients for paraneoplastic panel testing and patients [for whom] I need neurology assistance. [It’s important to]…make sure that we're not missing something."

Jacob Sands, MD, the associate chief of the Lowe Center for Thoracic Oncology and oncology medical director of the International Patient Center at Dana-Farber Cancer Institute, shared insights regarding the identification of Lambert-Eaton myasthenic syndrome (LEMS) in patients with small cell lung cancer (SCLC).

Sands began by emphasizing that medical oncologists are uniquely positioned to recognize when a patient requires paraneoplastic panel testing and when to request formal assistance from neurologists. Of note, a significant update was made to the National Comprehensive Cancer Network (NCCN) Guidelines in August 2025 to include new information on diagnosing LEMS, along with a specific revision regarding symptom specificity. Under the new recommendations, a diagnosis should ideally involve a neurological evaluation performed in consultation with a neurologist. Although the addition of LEMS testing to the guidelines is a positive development, Sands cautioned that clinicians must remain vigilant to ensure that a focus on LEMS does not lead to missing other paraneoplastic neural networks.

In clinical practice, identifying patients with LEMS often begins with recognizing proximal muscle weakness, which Sands identified as a common symptom in this population. He described 2 primary categories of suspicion: patients with weakness where negative testing provides enough comfort to continue monitoring, and patients where ongoing symptoms require neurology assistance regardless of whether paraneoplastic panel testing is positive. In the latter group, a specialist's input is essential to determine if the issue is truly neurological or stems from another underlying cause, Sands asserted.

Ultimately, Sands noted that the primary objective for those in medical oncology is to identify the patients who require deeper investigation to ensure they are not missing a diagnosis. By integrating the updated NCCN recommendations for testing and specialist consultation, oncology teams can better manage the complex overlap between oncologic and neurologic symptoms.