Screening & Local Therapy
According to current screening recommendations at what minimum pack-year smoking history and age range should adults be offered annual LDCT lung cancer screening?
20 pack-years; ages 50–80 (currently smoking or quit within 15 years)
Reference: https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/lung-cancer-screening
Why should ctDNA clearance not be interpreted as eradication of all residual disease in early-stage NSCLC?
Limited MRD sensitivity 4/5
Reference: Newman M et al. ctDNA Dynamics as Predictor of OS: NEO-lung Study. Nature Medicine. 2024
This actionable molecular alteration, present in approximately 3–4% of NSCLC cases, is associated with poor prognosis and has led to the development of selective targeted therapies that are now recommended in both first-line and subsequent treatment settings.
MET exon 14 skipping mutation or RET mutation
Reference: https://pubmed.ncbi.nlm.nih.gov/37492039/
In NSCLC patients with PD-L1 ≥50% and no driver mutations, adding chemotherapy to pembrolizumab has not consistently shown superior OS. What remains the preferred first-line standard?
Pembrolizumab monotherapy
Reference: https://pmc.ncbi.nlm.nih.gov/articles/PMC13083314/
A 62-year-old smoker undergoing LDCT screening is found to have a 7-mm subsolid nodule with a 2-mm increase in its solid component over 3 months. Despite Fleischner recommendations favoring surveillance for many subsolid nodules, what is the most appropriate next step?
Biopsy
Reference: de Koning H et al. The NELSON Lung Cancer Screening Study. Radiology. 2020;294(2):340-349.
Which acquired EGFR mutation is the classic on-target mechanism of resistance to osimertinib that may restore sensitivity to first-generation EGFR TKIs?
Answer: C797S
Reference: EGFR-RESIST Trial: Mechanisms of Osimertinib Resistance. 2025.
What targeted agent is now considered the preferred first-line therapy for resectable or metastatic EGFR-mutated NSCLC because of its CNS penetration and overall survival benefit?
Osimertinib
Reference: https://link.springer.com/article/10.1007/s11912-026-01751-0
In patients with resected stage IB–IIIA NSCLC, which perioperative therapy has demonstrated a significant improvement in disease-free survival and overall survival when administered as neoadjuvant chemoimmunotherapy before surgery?
Nivolumab plus platinum-based chemotherapy
Reference: https://www.nejm.org/doi/full/10.1056/NEJMoa2202170
In a 69-year-old patient with FEV1 32%, DLCO 28%, and a 2.3-cm stage IA2 NSCLC, what is the preferred treatment modality?
Stereotactic Body Radiation Therapy (SBRT)
Reference: Shen Y et al. Pulmonary Function and Postoperative Outcomes: Lobectomy vs. Sublobar. Ann Surg. 2022.
After progression on osimertinib, which targeted strategy is preferred?
Amivantamab and chemotherapy 3/5
Reference: EGFR-RESIST Trial: Mechanisms of Osimertinib Resistance. 2025.
This ALK inhibitor demonstrated the highest intracranial response rate and a 3-year progression free survival of 64%, challenging the notion of a single ALK standard of care.
Lorlatinib
Reference: Efficacy and safety of first-line lorlatinib versus crizotinib (CROWN study update)
The Lebanese economic crisis created widespread interruptions and dose reductions in first-line immunotherapy for metastatic NSCLC, yet progression-free survival remained largely preserved, challenging assumptions regarding this property of immune checkpoint inhibitors.
Dose-dependent efficacy
Reference: Effects of Lack of Access to Immunotherapy Medications on Survival of Lung Cancer Patients
Consolidative SBRT (Stereotactic Body Radiation Therapy) to oligometastatic sites after systemic therapy has shown PFS benefit in NSCLC. What is the generally accepted maximum number of metastatic sites for this approach?
3 to 5 oligometastatic sites 4/5
Reference: https://www.sciencedirect.com/science/article/pii/S016950022300822X
What promising biomarker in NSCLC has demonstrated significant prognostic value but remains absent from routine clinical practice because of insufficient prospective validation?
Circulating miRNA (microRNA)
Reference: https://pmc.ncbi.nlm.nih.gov/articles/PMC6096285/
What is the most common histological subtype of non-small cell lung cancer worldwide?
Adenocarcinoma
This strategy became an accepted alternative to prophylactic cranial irradiation in extensive-stage small-cell lung cancer after a randomized study showed comparable survival while avoiding PCI-associated neurocognitive toxicity.
MRI brain surveillance every 3 months
Reference: https://pmc.ncbi.nlm.nih.gov/articles/PMC11319250/
A 58-year-old patient presents with a Pancoast tumor causing shoulder pain, Horner's syndrome, and hand weakness. Which lung cancer location classically produces this presentation?
What is the most common actionable driver mutation found in NSCLC adenocarcinoma among never-smokers?
EGFR mutation
Reference: https://peachealth.com/content/cancer-mutations-in-non-smoking-lung-cancer
In NSCLC, what biomarker is routinely tested to help select patients most likely to benefit from single-agent checkpoint inhibitor immunotherapy?
PD-L1 expression
Reference: https://pmc.ncbi.nlm.nih.gov/articles/PMC10418476/
After completion of definitive concurrent chemoradiotherapy in limited-stage SCLC, which consolidation therapy has recently shown an overall survival benefit and changed standard practice?
Durvalumab consolidation
Reference: https://www.nejm.org/doi/full/10.1056/NEJMoa2404873