Biomarker Testing in Patients With Solid Tumors: Interactive Case Challenge for NSCLC

CE / CME

Biomarker Testing in Patients With Solid Tumors: Interactive Case Challenge for NSCLC

Nurse Practitioners/Nurses: 0.50 Nursing contact hours, includes 0.50 hour of pharmacotherapy credit

Physician Assistants/Physician Associates: 0.50 AAPA Category 1 CME credit

Released: June 16, 2026

Expiration: December 15, 2026

Beth Sandy, MSN, CRNP, FAPO

CME/CE Information

Activity

Progress

1 2

Course Completed

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Patient History/Initial Presentation
A 68-year-old woman presents with a persistent dry cough and new back pain. Workup shows a large spinal metastasis, and a CT scan of chest/abdomen/pelvis reveals a large left upper lobe lung mass. She is diagnosed with stage IV lung cancer, pending confirmation of full metastatic extent and pathology as clinically appropriate.

Her social history is notable for approximately 2 pack-years of smoking during college, with cessation approximately 50 years ago. For practical purposes, she has minimal remote smoking exposure; however, broad biomarker testing is indicated for advanced lung adenocarcinoma regardless of smoking history. Bronchoscopy with biopsy of the left upper lobe mass confirms lung adenocarcinoma, and in-house PD-L1 immunohistochemistry testing shows PD-L1 expression of 10%. Reflex biomarker testing is initiated once adenocarcinoma is identified based on institutional protocols. When she presents to medical oncology, PD-L1 status is available, but the broader molecular/next-generation sequencing (NGS) report is still pending and expected within approximately 2-3 weeks.

Your patient has newly diagnosed metastatic lung adenocarcinoma with PD-L1 expression of 10% by immunohistochemistry, and broad-panel NGS is still pending. She is clinically stable, scared, and wants to start treatment immediately.

What is the most appropriate information that you would communicate to her as the next step in her care and the reason supporting it?

A .
We would like to wait for your molecular results before choosing treatment because they may help identify the best option for you

63.6%
B .
We can start chemotherapy and immunotherapy now, then add targeted therapy if your NGS results show an actionable biomarker

13.6%
C .
We should avoid immunotherapy because it does not work as well in PD-L1 10% lung cancer and is too toxic

9.1%
D .
We should wait for molecular results mainly to plan targeted therapy if you need second-line treatment

13.6%

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