American Board of Internal Medicine (ABIM) Certification Practice Exam

What is the first line treatment for extensive-stage lung cancer?

1. Radiotherapy

2. Surgery

3. Platinum-containing chemotherapy

4. Supportive care

The correct answer is: Platinum-containing chemotherapy

In patients with extensive-stage lung cancer, which is often characterized by metastasis beyond the lungs and associated lymph nodes, the primary treatment approach is systemic therapy. Platinum-containing chemotherapy is the first-line treatment because it effectively addresses the cancer cells that have spread throughout the body. This chemotherapy is typically combined with other agents that enhance its efficacy, making it a standard, well-established treatment for advanced disease. The rationale for choosing platinum-containing chemotherapy as the first line is grounded in clinical studies showing significant improvements in survival and symptom control when compared to other interventions like radiotherapy or surgery. These other options, while useful in specific situations, are not suitable for extensive-stage lung cancer as they do not provide the systemic treatment necessary to tackle widespread disease. Additionally, supportive care is essential but primarily aims to alleviate symptoms rather than treat the underlying cancer. Thus, in the context of extensive-stage lung cancer, the focus is on systemic chemotherapy due to its effectiveness in managing this serious condition.