For metastatic large cell neuroendocrine carcinoma of lung, would you treat as small cell with platinum/etoposide/atezolizumab or would you treat as NSCLC and use platinum doublet/pembrolizumab?

Can consider NGS and treat like SCLC if there is Rb/p53 mutation pattern and NSCLC if STK11/KEAP1 pattern (later prob Immunotherapy resistant?)

https://www.esmo.org/Conferences/Past-Conferences/ESMO-2017-Congress/News-Articles/Improved-Survival-Demonstrated-with-NSCLC-chemotherapy-in-Pulmonary-Lar...

I treat metastatic LCNEC as NSCLC non-squamous. Rationale is that NSCLC trials such as KN-189 and IMPOWER 150 have included these patients (<5% of the cohort) but not IMPOWER 133 (SCLC). In addition, pemetrexed is active in stage 3 setting per PROCLAIM study. Nevertheless, no consensus on this rare ...