NSCLC Case Study 2: A Never-Smoker with Neuroendocrine Markers

Experts address a complex case of a never-smoker with early-stage non-small cell lung cancer (NSCLC). The diagnosis is complicated by ambiguous neuroendocrine markers on the biopsy, a PD-L1 score of 0%, and a negative NGS panel for common drivers, which is unusual for a never-smoker.

The panel recommends a multidisciplinary approach, starting with an EBUS biopsy for accurate lymph node staging and to obtain more tissue. They emphasize the need to repeat comprehensive genomic profiling with an RNA-based NGS test to rule out rare gene fusions that may have been missed. Given the patient's status as a never-smoker with PD-L1 negative disease, they conclude she is unlikely to benefit from immunotherapy. Therefore, the recommended treatment path is upfront surgery followed by consideration of adjuvant chemotherapy. The surgical specimen would also provide more tissue for further biomarker testing to guide future care if needed.