Test Your Skills: Advanced NSCLC

CE / CME

Test Your Skills: Individualizing Treatment for Patients With Advanced NSCLC

Physician Assistants/Physician Associates: 0.25 AAPA Category 1 CME credit

Nurses: 0.25 Nursing contact hour

Pharmacists: 0.25 contact hour (0.025 CEUs)

Physicians: maximum of 0.25 AMA PRA Category 1 Credit

ABIM MOC: maximum of 0.25 Medical Knowledge MOC point

Released: September 13, 2024

Expiration: September 12, 2025

Activity

Progress
1 2
Course Completed

History
A 60-year-old woman with a history of smoking (20 pack-years) is referred to a pulmonologist after presenting with a cough for the past 4 months with small volume hemoptysis and posterior right upper chest pain that did not improve with antibiotics.

Current Presentation
Her pulmonologist sent her for a chest CT scan that showed a 12.5 x 6.7–cm heterogeneously enhancing right upper lobe mass, with mediastinal lymphadenopathy at multiple nodal stations. PET scan showed a hypermetabolic focus in the T7 vertebra, suggesting metastasis.

Flexible bronchoscopy showed complete occlusion of the right upper lobe bronchus with transbronchial tumor and enlarged lymph nodes at stations 4R and 7. Transbronchial biopsy of the mass and fine-needle aspiration (FNA) cytology of 4R lymph node are both positive for a poorly differentiated NSCLC, favoring adenocarcinoma.

The patient is fit, has minimal symptoms, and can perform daily functions.

What is the most appropriate next step for this patient?