American Board of Internal Medicine (ABIM) Certification Practice Exam

What is the standard treatment for metastatic non-small cell lung cancer (NSCLC)?

1. Radiation therapy

2. Surgery

3. Chemotherapy

4. Targeted therapy

The correct answer is: Chemotherapy

The standard treatment for metastatic non-small cell lung cancer (NSCLC) is chemotherapy. This approach is primarily used because metastatic NSCLC indicates that the cancer has spread beyond the lungs to other parts of the body, making it more challenging to treat with localized therapies such as surgery or radiation. Chemotherapy uses systemic medications that can circulate through the bloodstream, targeting cancer cells at various sites of metastasis. In many cases of metastatic NSCLC, physicians may utilize combination chemotherapy regimens that include multiple agents, enhancing effectiveness against the cancer. Additionally, newer treatment modalities like immunotherapy and targeted therapies have become increasingly important in recent years, especially in cases with specific genetic mutations or tumor markers. However, chemotherapy remains a cornerstone of the treatment regimen, particularly when considering the overall clinical management of metastatic disease. While radiation therapy may play a role in relieving symptoms or treating specific areas affected by metastases, it is not the first-line treatment choice for disseminated disease. Surgery typically is not performed in the setting of metastatic cancer since it does not address the spread of the disease, and targeted therapies, although effective for certain subsets of patients with specific mutations, are not universally applicable to all individuals with metastatic NSCLC and often complement rather than replace chemotherapy.