NSCLC in never-smokers presents with a unique set of clinical, pathological, and genetic features. Adenocarcinoma predominates, as do tumors that carry EGFR mutations and, to a lesser and mutually exclusive extent, ALK rearrangements. Never-smokers generally have a better prognosis than former or current smokers, and as a group better responses to EGFR TKIs. EGFR and ALK genotyping is recommended for NSCLC patients presenting with adenocarcinoma, and should prove to have high therapeutic and clinical value in the never-smoker patient group.22  Multiple studies have demonstrated high response rates and improved survival when treatment is matched to genotype, but to date a treatment algorithm uniquely for never-smokers has not been developed.10

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