In general, this would represent the recommended treatment options
for lung
cancer. There are no clear guides as what drug is best after 3 lines of therapy, hence the reluctance to recommend any treatment.
I am also guessing that the adrenal involvement cannot be removed with surgery, hence, this is not given as an option. You are right, that there are some people who even have brain involvement and undergo surgery, but these cases are really the exceptions more than the rule.