Do you have any special diagnostic or treatment considerations when evaluating never-smokers with metastatic small cell lung cancer?

There is an increased risk of developing small cell lung cancer (SCLC) with prolonged exposure to radon, although not all studies have found this association in never smokers (Barros-Dios et al., PMID 22539606). It wouldn't hurt to ask if the home has been tested.

I would be very interested in sending next generation sequencing on small cell carcinoma in a never smoker, as 3-10% of patients with EGFR-mutated adenocarcinoma will transform into SCLC. Clues to transformation from a previous EGFR-mut...

I will consider NGS testing but even if an oncogenic driver is found, targeted therapy is unlikely to work. What I will do is repeat biopsy to evaluate if there is mixed NSCLC present, which increases the probability of response to targeted therapy. However, SCLC component still needs to be addressed separately with SCLC-directed chemotherapy.