A second important conclusion is that the “left-shift” toward more limited metastatic spread within stage IV, evident as fewer metastatic sites, lower serum LDH and a better ECOG PS for “secondary” compared to de novo cases (Figure 1D), does not have a significant impact on the outcome of TKI-treated EGFR+ NSCLC (Table 1). This evidence concerns the gene EGFR and non-small cell lung carcinoma.