{"entity":{"id":"lung-cancer","kind":"cancer","name":"Lung cancer (all types)","aka":["Bronchogenic carcinoma","Lung carcinoma","Cancer of the lung","Trachea, bronchus and lung cancer","Lung and bronchus cancer","Carcinoma of the lung"],"tldr":"Lung cancer splits into non-small-cell disease, about 85 percent of it, and small-cell disease, which was 6.6 percent of English cases in 2024 and 9.1 percent of Welsh ones (National Lung Cancer Audit, State of the Nation 2026); the two behave and are treated very differently. Screening, staging and the things both types share are common ground; the rest belongs to each subtype.","summary":"Lung cancer is divided by histology into non-small-cell lung cancer, itself split into adenocarcinoma, squamous and large-cell carcinoma, and small-cell lung cancer, a fast-growing neuroendocrine tumour almost always linked to smoking. Non-small-cell disease has more than a dozen targetable driver mutations and is treated with surgery, radiotherapy, targeted drugs and immunotherapy by stage and biology; small-cell disease is treated with chemotherapy, immunotherapy and radiotherapy and relapses quickly. Low-dose CT screening of heavy smokers cuts lung cancer deaths by about a fifth, and tobacco control remains the largest lever. Mesothelioma and thymic tumours are separate thoracic cancers.\n\nHow the family is organised. Four classifications of lung cancer are in daily use at once and they do not nest. The World Health Organization's Classification of Thoracic Tumours, fifth edition (2021), names the tumour types: adenocarcinoma and its patterns, squamous cell carcinoma, large cell carcinoma, the sarcomatoid carcinomas, adenosquamous carcinoma, the salivary-gland-type tumours, and a separate chapter of neuroendocrine neoplasms holding typical carcinoid, atypical carcinoid, large cell neuroendocrine carcinoma and small cell carcinoma. The NCI's PDQ summaries use the clinical split instead, one summary for non-small-cell lung cancer and one for small-cell lung cancer, because that split decides the first fork of treatment. The molecular subsets (EGFR-mutant, ALK-rearranged, ROS1, KRAS G12C, MET exon 14, RET, BRAF, HER2, NTRK, NRG1) decide the second fork but are states a tumour is in rather than types of tumour, and no classification lists them as entities. On this site the family reads: lung cancer, then non-small-cell and small-cell, then the histologies under non-small-cell, with large cell neuroendocrine carcinoma sitting beside the clinical split rather than inside it because it belongs to neither. Mesothelioma arises from the pleura and is not a lung cancer, however close it sits in the chest.\n\nHow common it is, worldwide. Lung cancer is the commonest cancer in the world and the commonest cause of cancer death, and it is the only cancer that tops both lists. The IARC fact sheet, served with the GLOBOCAN 2024 estimates, counts 2,637,005 new cases a year (age-standardised rate 23.9 per 100,000) and 1,861,839 deaths (16.3 per 100,000). Asia carries 1,730,334 of the cases (65.6 percent) and 1,196,664 of the deaths (64.3 percent); Europe 478,683 and 369,740 (18.2 and 19.9 percent); Northern America 258,423 and 151,406 (9.8 and 8.1 percent); Latin America and the Caribbean 103,726 and 89,548; Africa 47,006 and 41,045; Oceania 18,833 and 13,436. The highest national rate in men is Hungary at 61.8 per 100,000, and in women Hungary and Denmark at 36.0. Five-year prevalence is lower relative to yearly incidence than for most cancers, because survival after a lung cancer diagnosis is shorter: 2,345,582 of the world's prevalent cases are in Asia (65.7 percent).\n\nWhich types, and in what proportion. Using the GLOBOCAN 2022 base with the recorded incidence of Cancer Incidence in Five Continents volume XII, of 1,572,045 lung cancers in men worldwide 717,211 (45.6 percent) were adenocarcinoma, 461,171 (29.4 percent) squamous cell carcinoma, 180,063 (11.5 percent) small-cell carcinoma and 101,861 (6.5 percent) large-cell carcinoma; of 908,630 in women, 541,971 (59.7 percent) were adenocarcinoma, 155,598 (17.1 percent) squamous, 87,902 (9.7 percent) small-cell and 59,271 (6.5 percent) large-cell (Lancet Respiratory Medicine 2025). Adenocarcinoma is now the commonest type in both sexes everywhere the data allow the question to be asked, and the highest adenocarcinoma rates are in east Asia (27.12 per 100,000 men, 19.04 per 100,000 women). The same study attributed 114,486 male and 80,378 female adenocarcinomas in 2022 to ambient particulate matter pollution.\n\nThe United Kingdom. Lung cancer is the 3rd commonest cancer in the UK, with around 50,200 new cases a year, nearly 140 a day, 11 percent of all new cancer cases: about 25,500 in males and 24,700 in females (Cancer Research UK, 2019 and 2021 to 2022). It is the commonest cause of cancer death, with around 32,800 deaths a year, 90 a day (2022 to 2024). Almost half of new cases (46 percent) are in people aged 75 and over, and rates are highest at 80 to 84. Incidence has fallen about 11 percent since the early 1990s and 5 percent in the last decade; mortality has fallen 40 percent since the early 1970s and 22 percent in the last decade. The lifetime risk of a diagnosis is nearly 1 in 13 for females and 1 in 14 for males born in 1961 (both about 7 percent).\n\nThe United States. The SEER programme projects 229,410 new cases (10.8 percent of all cancers) and 124,990 deaths (20.0 percent of all cancer deaths) for 2026, which makes lung and bronchus cancer the 3rd commonest cancer diagnosed and by a wide margin the commonest cause of cancer death. The rate of new cases is 47.2 per 100,000 a year (2019 to 2023) and the death rate 30.2 (2020 to 2024); both are falling, incidence by 1.9 percent a year over 2014 to 2023 and mortality by 4.1 percent a year over 2015 to 2024, the fastest fall of any common cancer. The median age at diagnosis is 71 and at death 73; about 5.2 percent of Americans will be diagnosed in their lifetime; 661,853 people were living with the disease in 2023. Rates differ by group: 63.7 per 100,000 in non-Hispanic Black men and 57.0 in non-Hispanic White men against 29.8 in Hispanic men; 50.9 in non-Hispanic White women and 48.6 in non-Hispanic American Indian and Alaska Native women against 23.2 in Hispanic women.\n\nScreening, in one paragraph. Two randomised trials carry the case. The National Lung Screening Trial randomised 53,454 Americans aged 55 to 74 with at least 30 pack-years to three annual low-dose CT scans or chest radiographs and found 20.0 percent fewer lung cancer deaths (95 percent confidence interval 6.8 to 26.7) and 6.7 percent fewer deaths from any cause. NELSON randomised 13,195 men and 2,594 women aged 50 to 74 in the Netherlands and Belgium to volume CT at baseline and years 1, 3 and 5.5 or to nothing, and found a death rate ratio of 0.76 (0.61 to 0.94) in men at ten years and 0.67 (0.38 to 1.14) in women. The UK National Screening Committee recommended targeted screening at 55 to 74 for people at high risk in June 2022; England's Targeted Lung Health Check programme, running since 2019, became the national Lung Cancer Screening Programme and by March 2025 had invited over two million people and diagnosed 7,193 lung cancers, 63.1 percent at stage 1 and 12.6 percent at stage 2, with full coverage expected in 2030.\n\nWhat the family shares, and what it does not. Every type is staged by the same system, the ninth edition of the TNM classification, in force since 1 January 2025; every type is investigated down the same pathway of chest X-ray, contrast-enhanced CT, PET-CT and needle sampling of mediastinal nodes through the airway wall; and every type is caused overwhelmingly by the same exposure, so the same prevention works on all of them. What the family does not share is treatment: the driver-matched pills that transformed adenocarcinoma do nothing for squamous or small-cell disease, and the surgery that cures early non-small-cell disease is rarely the right operation for small-cell disease. The subtype pages carry the treatment; this page carries what is common.","asOf":"2026-09-25","wikipedia":"https://en.wikipedia.org/wiki/Lung_cancer","links":[{"label":"Wikipedia","url":"https://en.wikipedia.org/wiki/Lung_cancer"},{"label":"NCI PDQ","url":"https://www.cancer.gov/types/lung"},{"label":"GLOBOCAN trachea, bronchus and lung fact sheet (IARC Global Cancer Observatory, 2024 estimates)","url":"https://gco.iarc.who.int/media/globocan/factsheets/cancers/15-trachea-bronchus-and-lung-fact-sheet.pdf"},{"label":"SEER Cancer Stat Facts: lung and bronchus cancer (rates, stage distribution, survival by stage, age and race)","url":"https://seer.cancer.gov/statfacts/html/lungb.html"},{"label":"CRUK: lung cancer statistics (incidence, mortality, survival, early diagnosis, treatment)","url":"https://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/lung-cancer"},{"label":"CRUK: lung cancer incidence statistics","url":"https://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/lung-cancer/incidence"},{"label":"CRUK: lung cancer mortality statistics (including mortality by deprivation)","url":"https://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/lung-cancer/mortality"},{"label":"CRUK: lung cancer survival statistics (by age, deprivation and over time)","url":"https://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/lung-cancer/survival"},{"label":"CRUK: lung cancer risk factors (attributable fractions for the UK)","url":"https://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/lung-cancer/risk-factors"},{"label":"NHS: lung cancer","url":"https://www.nhs.uk/conditions/lung-cancer/"},{"label":"NHS: symptoms of lung cancer (when to see a GP, when to call 111 and when to call 999)","url":"https://www.nhs.uk/conditions/lung-cancer/symptoms/"},{"label":"NHS: lung cancer screening (who is invited to a lung health check and what happens)","url":"https://www.nhs.uk/tests-and-treatments/lung-cancer-screening/"},{"label":"NICE NG12: suspected cancer, recommendations by site (lung and pleural cancers 1.1.1 to 1.1.6)","url":"https://www.nice.org.uk/guidance/ng12/chapter/Recommendations-organised-by-site-of-cancer"},{"label":"NICE NG122: lung cancer, diagnosis and staging (published 28 March 2019, last updated 8 March 2024)","url":"https://www.nice.org.uk/guidance/ng122/chapter/Diagnosis-and-staging"},{"label":"NICE NG209: tobacco, preventing uptake, promoting quitting and treating dependence (published 30 November 2021, last updated 4 February 2025)","url":"https://www.nice.org.uk/guidance/ng209"},{"label":"UK National Screening Committee: lung cancer screening recommendation (June 2022 review)","url":"https://view-health-screening-recommendations.service.gov.uk/lung-cancer/"},{"label":"GOV.UK: new lung cancer screening roll out to detect cancer sooner (26 June 2023)","url":"https://www.gov.uk/government/news/new-lung-cancer-screening-roll-out-to-detect-cancer-sooner"},{"label":"National Lung Screening Trial Research Team, N Engl J Med 2011: reduced lung-cancer mortality with low-dose computed tomographic screening (53,454 people)","url":"https://doi.org/10.1056/nejmoa1102873"},{"label":"de Koning, N Engl J Med 2020: NELSON, reduced lung-cancer mortality with volume CT screening in a randomised trial (13,195 men and 2,594 women)","url":"https://doi.org/10.1056/nejmoa1911793"},{"label":"US Preventive Services Task Force, JAMA 2021: screening for lung cancer, recommendation statement (annual low-dose CT at 50 to 80 with 20 pack-years, grade B)","url":"https://doi.org/10.1001/jama.2021.1117"},{"label":"Jonas, JAMA 2021: screening for lung cancer with low-dose computed tomography, updated evidence report for the US Preventive Services Task Force (223 publications, 7 randomised trials, 86,486 people)","url":"https://doi.org/10.1001/jama.2021.0377"},{"label":"Nature Medicine 2026: implementation of the NHS England Lung Cancer Screening Programme over 5 years (over two million invited, 7,193 cancers to March 2025)","url":"https://doi.org/10.1038/s41591-026-04292-y"},{"label":"Br J Radiol 2025: something old something new, introduction to the ninth edition TNM classification of lung cancer (effective 1 January 2025)","url":"https://doi.org/10.1093/bjr/tqaf161"},{"label":"Rami-Porta, J Thorac Oncol 2024: IASLC lung cancer staging project, proposals for revision of the TNM stage groups in the forthcoming ninth edition (76,518 patients analysed of 124,581 registered)","url":"https://doi.org/10.1016/j.jtho.2024.02.011"},{"label":"Nicholson, J Thorac Oncol 2022: the 2021 WHO classification of lung tumours, impact of advances since 2015","url":"https://doi.org/10.1016/j.jtho.2021.11.003"},{"label":"Lancet Respir Med 2025: estimated worldwide variation and trends in incidence of lung cancer by histological subtype in 2022 and over time (GLOBOCAN 2022 with Cancer Incidence in Five Continents)","url":"https://doi.org/10.1016/s2213-2600(24)00428-4"},{"label":"BJC Reports 2023: lung cancer in never smokers, development of a UK national research strategy (127 surveys, 190 attendees)","url":"https://doi.org/10.1038/s44276-023-00006-w"},{"label":"NHS: tests and next steps for lung cancer","url":"https://www.nhs.uk/conditions/lung-cancer/tests-and-next-steps/"},{"label":"NHS: treatment for lung cancer","url":"https://www.nhs.uk/conditions/lung-cancer/treatment/"},{"label":"NHS: coughing up blood (blood in phlegm)","url":"https://www.nhs.uk/symptoms/coughing-up-blood/"},{"label":"NHS Better Health: quit smoking","url":"https://www.nhs.uk/better-health/quit-smoking/"},{"label":"NHS: genetic and genomic testing","url":"https://www.nhs.uk/tests-and-treatments/genetic-and-genomic-testing/"},{"label":"NHS: clinical trials","url":"https://www.nhs.uk/tests-and-treatments/clinical-trials/"},{"label":"NICE NG122: lung cancer, management","url":"https://www.nice.org.uk/guidance/ng122/chapter/Management"},{"label":"NICE NG122: lung cancer, palliative interventions and supportive and palliative care","url":"https://www.nice.org.uk/guidance/ng122/chapter/Palliative-interventions-and-supportive-and-palliative-care"},{"label":"NICE NG122: lung cancer, support from clinical nurse specialists","url":"https://www.nice.org.uk/guidance/ng122/chapter/Support-from-clinical-nurse-specialists"},{"label":"NICE NG122: lung cancer, follow-up and patient perspectives","url":"https://www.nice.org.uk/guidance/ng122/chapter/Follow-up-and-patient-perspectives"},{"label":"NICE NG234: spinal metastases and metastatic spinal cord compression, recommendations","url":"https://www.nice.org.uk/guidance/ng234/chapter/Recommendations"},{"label":"Roy Castle Lung Cancer Foundation: living with lung cancer","url":"https://roycastle.org/learn-about-lung-cancer/living-with-cancer/"},{"label":"Roy Castle Lung Cancer Foundation: the support available to you","url":"https://roycastle.org/our-support/"},{"label":"Roy Castle Lung Cancer Foundation: stop smoking","url":"https://roycastle.org/our-support/stop-smoking/"},{"label":"Roy Castle Lung Cancer Foundation: getting diagnosed","url":"https://roycastle.org/learn-about-lung-cancer/getting-diagnosed/"},{"label":"Roy Castle Lung Cancer Foundation: lung cancer treatments","url":"https://roycastle.org/learn-about-lung-cancer/lung-cancer-treatments/"},{"label":"Macmillan: lung cancer","url":"https://www.macmillan.org.uk/cancer-information-and-support/lung-cancer"},{"label":"Macmillan: non-small cell lung cancer (NSCLC)","url":"https://www.macmillan.org.uk/cancer-information-and-support/lung-cancer/non-small-cell-lung-cancer"},{"label":"Macmillan: breathlessness","url":"https://www.macmillan.org.uk/cancer-information-and-support/impacts-of-cancer/breathlessness"},{"label":"Macmillan: superior vena cava obstruction (SVCO)","url":"https://www.macmillan.org.uk/cancer-information-and-support/impacts-of-cancer/superior-vena-cava-obstruction"},{"label":"Cancer Research UK: living with lung cancer","url":"https://www.cancerresearchuk.org/about-cancer/lung-cancer/living-with"},{"label":"Cancer Research UK: coping with breathlessness when you have lung cancer","url":"https://www.cancerresearchuk.org/about-cancer/lung-cancer/living-with/coping-with-breathlessness"},{"label":"Cancer Research UK: coping and support when you have lung cancer","url":"https://www.cancerresearchuk.org/about-cancer/lung-cancer/living-with/coping"},{"label":"Cancer Research UK: fluid on the lungs (pleural effusion)","url":"https://www.cancerresearchuk.org/about-cancer/coping/physically/breathing-problems/fluid-on-lungs-pleural-effusion"},{"label":"Cancer Research UK: treatments to help you breathe when you have lung cancer","url":"https://www.cancerresearchuk.org/about-cancer/lung-cancer/treatment/help-you-breathe"},{"label":"Cancer Research UK: symptoms of metastatic lung cancer","url":"https://www.cancerresearchuk.org/about-cancer/lung-cancer/metastatic/symptoms"},{"label":"Cancer Research UK: oxygen at home","url":"https://www.cancerresearchuk.org/about-cancer/coping/physically/breathing-problems/treatment/oxygen-at-home"},{"label":"Cancer Research UK: lung cancer resources and support organisations","url":"https://www.cancerresearchuk.org/about-cancer/lung-cancer/living-with/resources-books"},{"label":"Asthma + Lung UK: breathlessness","url":"https://www.asthmaandlung.org.uk/symptoms-tests-treatments/symptoms/breathlessness"},{"label":"Asthma + Lung UK: how can I manage my breathlessness?","url":"https://www.asthmaandlung.org.uk/symptoms-tests-treatments/symptoms/breathlessness/how-can-i-manage-my-breathlessness"},{"label":"Maggie's: support and information","url":"https://www.maggies.org/support-and-information/"},{"label":"Marie Curie: what is palliative care?","url":"https://www.mariecurie.org.uk/information/getting-care/palliative-care"},{"label":"Temel et al., early palliative care for patients with metastatic non-small-cell lung cancer (NEJM 2010)","url":"https://doi.org/10.1056/NEJMoa1000678"}],"tags":["parent-page"],"related":["nsclc","sclc","lung-lcnec","lung-net","mesothelioma","pleuropulmonary-blastoma","lung-adenocarcinoma","lung-squamous-cell-carcinoma","lung-cancer-evidence-roadmap","idea-lung-screening-eligibility-by-risk-not-pack-years","idea-lung-never-smoker-disease-its-own-programme","idea-lung-resistance-directed-sequencing-at-every-progression","idea-lung-brain-metastasis-prevention-as-a-primary-endpoint","idea-lung-deprivation-gradient-treated-as-a-defect-in-delivery","idea-lung-small-cell-platform-with-shared-controls-and-subtypes","idea-lung-uk-screening-testing-and-access-gaps"],"cancers":[],"sections":[],"technologies":["low-dose-ct-screening","nhs-targeted-lung-health-check","ct","pet","histopathology-ihc","palliative-care","palliative-radiotherapy","psycho-oncology","peer-support-groups","oncology-nutrition","pain-management","prehabilitation","eras-perioperative-nutrition","survivorship-care-plan","multidisciplinary-tumour-board","financial-navigation","cbt-fatigue-distress","exercise-during-chemotherapy","liquid-biopsy","sbrt","pet-ct","checkpoint-inhibitor","radiotherapy","imrt-igrt","ngs","wes-wgs","ihc","fish","bronchoscopy","kinase-inhibitors","t-cell-engager","adc","stereotactic-radiosurgery"],"targets":["egfr","alk","ros1","ret","met","kras","braf","her2","ntrk","dll3","tp53","rb1","pd1"],"drugs":["osimertinib","amivantamab","lazertinib","gefitinib","erlotinib","afatinib","crizotinib","alectinib","lorlatinib","brigatinib","entrectinib","selpercatinib","capmatinib","tepotinib","sotorasib","adagrasib","dabrafenib","trametinib","trastuzumab-deruxtecan","pembrolizumab","nivolumab","atezolizumab","durvalumab","cemiplimab","tarlatamab","bevacizumab","ivonescimab","zongertinib","datopotamab-deruxtecan","tremelimumab","ceritinib","pralsetinib","vinorelbine","gemcitabine","paclitaxel","pemetrexed","cisplatin","carboplatin","etoposide","docetaxel","topotecan","lurbinectedin"],"companies":[],"institutions":[],"pathways":[],"terms":["targeted-lung-health-check","pack-year","never-smoker-lung-cancer","tnm-9-lung-cancer","radon","asbestos","smoking-cessation","haemoptysis","pulmonary-nodule","lung-rads","pancoast-tumour","ttf1-p40","tnm-staging","performance-status","malignant-pleural-effusion","superior-vena-cava-obstruction","lobectomy","segmentectomy","pneumonectomy","bronchoscopy","radiation-pneumonitis","irae","immune-colitis","pleural-effusion","pleurodesis","brain-metastases","bone-metastases","cancer-related-fatigue","anaemia","cachexia","curative-intent","late-effects","ngs","ctdna","neutropenia","febrile-neutropenia","pdl1","tps","tmb","driver-mutation","oncogene-addiction","resistance","mrd","prophylactic-cranial-irradiation","chemoradiation","neoadjuvant-adjuvant","histology","clonal-evolution","overdiagnosis","oligometastatic","screening","lung-trials-open-today","lung-palliation-breathlessness-effusion-obstruction","lung-failed-programmes","lung-uk-drug-access"],"trials":["nlst-nelson","pacific","flaura2","mariposa","laura","alina","alex","crown","adriatic","caspian","impower133","dellphi-304","codebreak-200","geometry-mono-1","lung-map"],"people":[],"bottlenecks":["b-early-detection","b-prevention-adoption","b-resistance","b-immunotherapy-response","b-brain-delivery","b-tumor-heterogeneity","b-rare-cancers","b-global-access","b-biomarker-validation","b-care-fragmentation","b-toxicity-qol","b-trial-diversity"],"keyPapers":[],"journals":[],"dependsOn":[],"notes":["Is lung cancer one disease? No, and the ways of dividing it do not nest. Pathologists use the World Health Organization's classification of tumour types; oncologists use the split between small-cell and non-small-cell disease, because that decides the first fork of treatment; and within non-small-cell disease a set of driver mutations decides the second fork. This page is the family; the type pages carry the treatment. Mesothelioma, which grows from the lining around the lung rather than from the lung, is a different cancer and is not on this page.","How common is it? It is the commonest cancer in the world and the commonest cause of cancer death, the only cancer that leads both lists: 2,637,005 new cases and 1,861,839 deaths a year (GLOBOCAN 2024). In the UK there are around 50,200 cases and 32,800 deaths a year, the 3rd commonest cancer and the commonest cause of cancer death (Cancer Research UK). In the United States 229,410 cases and 124,990 deaths are projected for 2026 (SEER).","What proportion is caused by smoking? Cancer Research UK attributes 72 percent of UK cases to tobacco, 71 percent to active smoking and 1 percent to second-hand smoke, and about 86 percent of UK lung cancer deaths. Seventy-nine percent of UK cases are judged preventable altogether once workplace exposures, air pollution and radon are counted.","Does stopping help once you have smoked for years? Yes, and the earlier the better. Of British men who smoke all their lives 15.9 percent die of lung cancer by 75; of those who stop by 60, 9.9 percent; by 50, 6 percent; by 40, 3 percent; by 30, 1.7 percent. In women the figures are 9.5 percent for lifelong smokers, 5.3 percent for stopping by 60 and 2.2 percent by 50 (Cancer Research UK).","I have never smoked. Can I still get lung cancer? Yes. Fifteen percent of UK lung cancers are in people who have never smoked, which would make it the 8th commonest cancer in the UK on its own, and worldwide the figure is 15 to 25 percent (BJC Reports 2023; Health Science Reports 2026). It is usually adenocarcinoma, it is commoner in women, and it is more likely to carry a mutation a drug can target. Second-hand smoke accounts for an estimated 15 percent of never-smoker cases, radon and air pollution for more.","Who is offered NHS lung screening, and what happens? In England, people aged 55 to 74 whose GP record shows they smoke or used to are invited to a lung health check, by phone, online or in person. The check asks about breathing, lifestyle and family history and measures height and weight; a risk model then decides whether a CT scan follows. Scans may be in a mobile unit in a car park or at a hospital, take a few minutes, and results arrive within four weeks. Anyone who still smokes is offered help to stop at the same appointment. The programme is being rolled out area by area, starting where lung cancer rates are highest, with full coverage expected in 2030 (NHS; Nature Medicine 2026).","Does screening actually save lives? Yes, shown in randomised trials rather than inferred. Three annual low-dose CT scans cut lung cancer deaths by 20.0 percent in 53,454 Americans (National Lung Screening Trial 2011), and four rounds of volume CT cut them by 24 percent in Dutch and Belgian men at ten years (NELSON 2020). It takes 323 people screened over 6.5 years, or 130 over ten years, to prevent one lung cancer death.","What are the harms of screening? In the National Lung Screening Trial 24.2 percent of CT screens were called positive and 96.4 percent of those were false alarms; false positives led to 17 invasive procedures per 1,000 people screened, with fewer than one major complication. Incidental findings turned up in 4.4 to 40.7 percent of people screened. Overdiagnosis, finding a cancer that would never have caused harm, has been estimated at anywhere from 0 to 67 percent, which is the least settled number in the field. NELSON's protocol, which measures nodule volume and growth rather than diameter, referred only 2.1 percent of participants, and modern nodule protocols are expected to reduce the false-positive burden.","Why do I keep hearing the staging has changed? Because it has. The ninth edition of the TNM classification came into force on 1 January 2025. The T categories are unchanged; N2 was split into N2a (one mediastinal station) and N2b (several), M1c was split by the number of organ systems involved, and several stage groups moved as a result. A person staged in 2024 and a person staged in 2025 can carry different stage labels for the same disease, which matters when comparing survival figures.","What is the outlook? Averages hide a wide range and are dominated by how late the disease is found. In the United States 29.5 percent of people are alive at five years, which rises to 65.5 percent for the 24 percent found while the cancer is still confined to the lung and falls to 10.5 percent for the 51 percent found after it has spread (SEER). In the UK 11.1 percent survive ten years or more, up from 3.3 percent in the 1970s, and survival is higher in women than men and falls steeply with age (Cancer Research UK). These figures predate the drugs and the screening programme now in use.","Living with lung cancer, care and decisions: This is orientation from public patient pages and guidelines, not advice for your case: your own team's instructions and 24-hour number come first. The nine decision rows above, the question sets for the respiratory physician, thoracic surgeon, oncologist, genomics and palliative care appointments, the first 60 days checklist and the red cards were written from NICE NG122 and NG234 and the NHS, Roy Castle Lung Cancer Foundation, Macmillan, Cancer Research UK, Asthma + Lung UK, Maggie's and Marie Curie patient pages, all read on 25 September 2026.","On smoking and stigma. Lung cancer is the cancer people are most often asked whether they smoked, and the question reaches people who smoke, people who stopped decades ago and people who never smoked. Nothing in this record treats the diagnosis as a consequence. Stopping smoking appears here as a treatment recommendation with a named benefit, because NICE NG122 (1.3.1 and 1.3.2) says smoking increases the risk of lung complications after surgery and that people should be advised to stop as soon as the diagnosis is suspected and told why; the same section (1.3.3) says not to postpone surgery to allow people to stop, which means treatment is not conditional on it. Roy Castle Lung Cancer Foundation says quitting after a diagnosis may help you respond better to treatment and lists what is available. Nobody has to earn their treatment."],"group":"lung","burden":"The commonest cancer in the world and the commonest cause of cancer death, the only cancer that tops both lists: 2,637,005 new cases and 1,861,839 deaths a year (GLOBOCAN 2024), with 65.6 percent of cases in Asia. Around 50,200 UK cases and 32,800 UK deaths a year, the 3rd commonest cancer and the commonest cause of cancer death (Cancer Research UK); 229,410 US cases and 124,990 deaths projected for 2026 (SEER). Adenocarcinoma is the commonest type in both sexes, and 72 percent of UK cases are caused by smoking.","subtypes":["Non-small-cell lung cancer (adenocarcinoma, squamous, large cell)","Small-cell lung cancer","Carcinoid and other neuroendocrine tumours of the lung","Pleuropulmonary blastoma (childhood)","Large cell neuroendocrine carcinoma of the lung"],"biomarkers":["EGFR, ALK, ROS1, KRAS G12C, BRAF V600E, MET exon 14, RET, NTRK, HER2 mutations (non-small-cell)","PD-L1 expression","Stage by TNM and PET-CT","Circulating tumour DNA for minimal residual disease","Histological type on a small biopsy, decided by TTF-1 and p40 immunohistochemistry before anything else"],"standardOfCare":[{"setting":"Referral when symptoms suggest lung cancer (UK)","approach":"Refer on the suspected cancer pathway for chest X-ray findings that suggest lung cancer, or for unexplained haemoptysis at 40 and over. Offer an urgent direct access chest X-ray at 40 and over for two or more of cough, fatigue, shortness of breath, chest pain, weight loss and appetite loss, or for one of them in anyone who has ever smoked. Consider one for persistent or recurrent chest infection, finger clubbing, supraclavicular or persistent cervical lymphadenopathy, chest signs consistent with lung cancer, or thrombocytosis. Mesothelioma has its own rules in the same section, with asbestos exposure lowering the threshold.","refs":["haemoptysis","ct"],"guideline":{"version":"NICE NG12: suspected cancer, recognition and referral (lung and pleural cancers 1.1.1 to 1.1.6)","url":"https://www.nice.org.uk/guidance/ng12"}},{"setting":"Prevention and stopping smoking","approach":"Tobacco control and stopping smoking, which is the only lever that reaches the 72 percent of UK cases caused by smoking. NICE NG209 covers preventing uptake in people aged 24 and under and treating dependence in everyone aged 12 and over, and was updated in February 2025 to add cytisinicline. Screening services carry smoking cessation with them, as the UK National Screening Committee required. Radon can be measured in a home and reduced; workplace exposures are regulated.","refs":["smoking-cessation","radon","asbestos"],"guideline":{"version":"NICE NG209: tobacco, preventing uptake, promoting quitting and treating dependence","url":"https://www.nice.org.uk/guidance/ng209"}},{"setting":"Early lung cancer: surgery, radiotherapy or both, and what your lung function means for the choice","approach":"For lung cancer that has not spread, the first question is not which treatment is strongest but which treatment your lungs can afford. NICE NG122 (1.5.1) says that for people who are well enough and for whom treatment with curative intent is suitable, offer lobectomy, either open or thoracoscopic, and (1.5.2) offer more extensive surgery only where it is needed to get clear margins. NICE's own explanation is that lobectomy gives better survival than stereotactic ablative radiotherapy and is a good compromise between preserving lung function and removing the cancer. The fitness assessment runs on numbers rather than on impressions: spirometry and transfer factor before any treatment with curative intent (1.4.9), a functional segment count to predict lung function after the operation (1.4.11), a shuttle walk test with 400 m as the cut-off for good function or an exercise test with 15 ml/kg/minute where the risk of breathlessness afterwards is moderate to high (1.4.13 and 1.4.14), and a global risk score such as Thoracoscore with the person told the risk before they consent (1.4.1). Where predicted lung function after surgery is low, the guideline does not close the door: it says to offer people with a predicted postoperative FEV1 or transfer factor below 30 percent the option of treatment with curative intent if they accept the risks of breathlessness and associated complications (1.4.12). Two branches follow. If you decline a lobectomy or it is contraindicated, NICE offers stereotactic ablative radiotherapy or a sublobar resection (1.5.5), and says the evidence does not establish which of those two is better. If you decline any surgery or none is possible, it offers stereotactic ablative radiotherapy, and conventional or hyperfractionated radiotherapy if that is contraindicated (1.5.8). Stereotactic radiotherapy is outpatient treatment over a handful of visits, which is why people often prefer it. Smoking sits inside this row rather than beside it: NICE says to explain that smoking increases the risk of lung complications after surgery and to advise stopping as soon as the diagnosis is suspected, and in the same section says not to postpone surgery to allow people to stop (1.3.1 to 1.3.3).","refs":["lobectomy","segmentectomy","pneumonectomy","sbrt","pet-ct","prehabilitation","performance-status"],"guideline":{"version":"NICE NG122 (2019, updated March 2024)","url":"https://www.nice.org.uk/guidance/ng122/chapter/Management"}},{"setting":"Treatment before or after surgery, and which results have to come back first","approach":"An operation is rarely the whole of the treatment for anything above the smallest tumours, and the order matters. Before surgery, NICE NG122 (1.6.8) recommends nivolumab with chemotherapy for neoadjuvant treatment of resectable disease at least 4 cm or node positive, and (1.6.9 and 1.6.10) durvalumab or pembrolizumab with platinum chemotherapy given before and then continued after the operation, durvalumab restricted to disease without EGFR mutations or ALK rearrangements. That restriction is why the molecular result has to be back before this decision is made rather than after it. After surgery, NICE (1.6.11) says to offer systemic anticancer therapy to people with good performance status and T1a to 4, N1 to 2, M0 disease, (1.6.12) to consider it for T2b to 4, N0, M0 tumours larger than 4 cm, and (1.6.13) to use a platinum-based combination. Where a targetable change is present the adjuvant treatment is a tablet instead: osimertinib after complete resection of stage 1b to 3a EGFR exon 19 deletion or L858R disease, stopped at 3 years or earlier on recurrence or unacceptable toxicity (1.6.14), and alectinib after complete resection of stage 1b (at least 4 cm) to 3a ALK-positive disease (1.6.15). For operable stage 3a N2 disease NICE (1.6.3 to 1.6.6) says to consider chemoradiotherapy with surgery, to discuss the benefits and risks first including that it improves progression-free survival and may improve overall survival, to schedule the operation 3 to 5 weeks after the chemoradiotherapy finishes so there is time to recover, and to do it only in teams with expertise in the combined treatment and in each of its parts. The practical questions this row generates are about sequence and waiting: what has to come back before we decide, how long the treatment before surgery adds, and what the pathology report will change afterwards.","refs":["nivolumab","durvalumab","pembrolizumab","osimertinib","alectinib","checkmate-816","keynote-671","adaura","alina","egfr","alk"],"guideline":{"version":"NICE NG122 (2019, updated March 2024)","url":"https://www.nice.org.uk/guidance/ng122/chapter/Management"}},{"setting":"Locally advanced lung cancer that cannot be removed: chemoradiotherapy, then a year of immunotherapy","approach":"Locally advanced lung cancer is the stage where the treatment is hardest and the intent is still cure. NICE NG122 (1.6.17) says to consider chemoradiotherapy for people with stage 2 or 3 disease whose condition is not suitable for surgery or who decline it, and to balance the potential survival benefit against the risk of additional toxicities, which is an unusually honest sentence for a guideline and worth quoting back in clinic. What follows the chemoradiotherapy is now part of the plan rather than an afterthought: NICE (1.6.18) recommends durvalumab for locally advanced unresectable disease with PD-L1 expression on 1 percent or more of tumour cells where the disease has not progressed after concurrent platinum-based chemoradiation; the schedule this came from, PACIFIC, gave it for a year. For people whose tumour carries an EGFR change, the corpus records LAURA, which tested osimertinib in the same position after chemoradiotherapy, so what is offered depends on both the PD-L1 result and the gene result and is worth asking about by name. Where chemoradiotherapy is too much, NICE (1.5.9 and 1.5.10) says to consider radical radiotherapy, conventional or hyperfractionated, for people with stage 3a or 3b disease who are eligible, while saying plainly that some people who cannot tolerate chemoradiotherapy will not manage radical radiotherapy either. The side effect that defines this row is inflammation of the lung: both the radiotherapy and the immunotherapy can cause it, the symptoms are identical (breathlessness, a cough that does not go away, wheezing, a fever over 37.5 C), and Macmillan's instruction for all of them is the same, which is to ring the 24-hour number straight away rather than wait for the next clinic.","refs":["durvalumab","pacific","laura","osimertinib","radiation-pneumonitis","checkpoint-inhibitor","pdl1"],"guideline":{"version":"NICE NG122 (2019, updated March 2024)","url":"https://www.nice.org.uk/guidance/ng122/chapter/Management"}},{"setting":"What a biomarker result changes once the cancer has spread, and why waiting for it is usually right","approach":"Once lung cancer has spread, the tumour's genes decide the first treatment more completely than in almost any other cancer, and the honest advice is usually to wait for the result. NICE NG122 (1.2.12) says to see the National Genomics Test Directory for guidance on next-generation sequencing panels to guide treatment, and (1.2.11) that samples must be adequate, without unacceptable risk to the person, to permit subtyping and assessment of molecular markers. The genes with a treatment attached that the record carries are EGFR, ALK, ROS1, KRAS G12C, BRAF V600, MET exon 14 skipping, RET fusions, HER2 mutations and NTRK fusions, and for most of them the matched tablet does better than what would otherwise be given first. The case for waiting is not only that a targeted drug might be missed. Some of the immunotherapy recommendations are written to exclude EGFR and ALK disease (NICE 1.6.9 does so explicitly for durvalumab around surgery), and a treatment started in the wrong lane is harder to undo than a fortnight of waiting. The case against waiting is real too, and belongs in the conversation: if someone is unwell, losing weight quickly or in pain, a team may sensibly start something now and change when the result lands. That is a judgement about the person, not a failure of the system, and the question to ask is what would be started and how fast the switch could happen. Where tissue is short, a blood test for circulating tumour DNA can sometimes answer sooner; it cannot show a change in how the cancer looks under the microscope, so it complements a biopsy rather than replacing it.","refs":["ngs","liquid-biopsy","ctdna","egfr","alk","ros1","kras-g12c","braf","met","ret","osimertinib","alectinib"],"guideline":{"version":"NICE NG122 (2019, updated March 2024)","url":"https://www.nice.org.uk/guidance/ng122/chapter/Diagnosis-and-staging"}},{"setting":"Which immunotherapy, and whether with chemotherapy, by the PD-L1 score","approach":"Where no targetable change is found, the first treatment for advanced lung cancer is immunotherapy, and the PD-L1 score decides whether it is given alone or with chemotherapy. NICE NG122 organises its published treatment pathways for advanced disease around exactly this split, separately for squamous and non-squamous cancer: no targetable mutations with PD-L1 below 50 percent, and no targetable mutations with PD-L1 at 50 percent or higher, with further pathways for RET fusion, KRAS G12C, MET exon 14 skipping and BRAF V600 disease at each PD-L1 level. In practice a high score opens the option of a checkpoint antibody on its own, which is a gentler treatment with fewer visits and no hair loss; adding chemotherapy works faster and is usually preferred when there is a lot of disease, when symptoms are pressing, or when the score is low. Neither is a better treatment in the abstract, and the question worth asking is which of those considerations is driving the recommendation for you. The trade-off in side effects is different in kind rather than in degree. Chemotherapy's effects are mostly predictable and temporary; immune effects are less predictable, can affect any organ, and Macmillan says they can begin during treatment or after it ends, which is why the alert card is issued and why the same short list is repeated at every visit: breathlessness, a new cough, wheezing or a fever over 37.5 C; more stools than is normal for you or stools at night; a spreading, blistering or peeling rash with flu-like symptoms; and feeling unwell even with a normal temperature.","refs":["pembrolizumab","atezolizumab","cemiplimab","nivolumab","ipilimumab","pdl1","keynote-042","keynote-407","checkmate-227","irae","checkpoint-inhibitor"],"guideline":{"version":"NICE NG122 (2019, updated March 2024)","url":"https://www.nice.org.uk/guidance/ng122/chapter/Management"}},{"setting":"When a targeted drug stops working (resistance): the second biopsy and what comes next","approach":"Targeted tablets work until the cancer finds a way round them, and planning for that in advance makes the day it happens less frightening. The first thing to establish is the pattern. One growing area with everything else stable is often treated locally, with stereotactic radiotherapy to that spot and the tablet continued; growth in several places usually means changing treatment. The second is whether to look at the cancer again. NICE NG122 (1.2.11) asks for samples adequate to permit pathological diagnosis including subtyping and assessment of molecular markers, and (1.2.13) to choose investigations that give the most information with the least risk to the person, thinking carefully before performing a test that gives only diagnostic pathology when other information is needed too. Applied at resistance, that is the argument for and against a repeat biopsy: it can show a new resistance mutation, an amplified second gene, or that the cancer has transformed into a different type entirely, and each of those points somewhere different. A blood test for tumour DNA is quicker and can find a new mutation, but it cannot see a transformation, so where that is the question tissue is still needed. What follows depends on what is found: a next-generation inhibitor of the same target, chemotherapy with or without an antibody, an antibody drug conjugate such as patritumab deruxtecan in the HERTHENA-Lung02 setting, or a trial. Trials usually require you to be well enough to take part, so this is the point at which to ask for the referral rather than several months later.","refs":["osimertinib","lorlatinib","patritumab-deruxtecan","herthena-lung02","liquid-biopsy","ctdna","sbrt","bronchoscopy"],"guideline":{"version":"NICE NG122 (2019, updated March 2024)","url":"https://www.nice.org.uk/guidance/ng122/chapter/Diagnosis-and-staging"}},{"setting":"Lung cancer that has spread to the brain","approach":"Lung cancer reaches the brain more often than most cancers, and the treatment has changed enough that old assumptions are worth putting down. NICE NG122 (1.16.1) says to offer dexamethasone to people with symptomatic brain metastases and to reduce to the minimum necessary maintenance dose for symptomatic response, and (1.16.2) refers the treatment itself to the section on management of confirmed brain metastases in its brain tumours guideline rather than repeating it. The practical choice is between focused radiotherapy to a small number of spots, whole-brain radiotherapy, surgery for a single accessible lesion, and, increasingly, a targeted tablet chosen because it crosses into the brain: several of the modern drugs recorded here were designed to do so, which can mean treating brain disease with tablets rather than radiotherapy. NICE is willing to say out loud that radiotherapy to the whole brain has a cost: writing about preventive brain radiotherapy in small-cell disease it says the treatment can adversely affect quality of life and that the survival benefits are limited. Which approach is proposed, and why, is therefore a reasonable question. The symptoms to know, from Cancer Research UK, are memory problems, mood or personality changes, seizures, confusion, severe headaches often with sickness, and weakness of an arm or a leg. Two practical matters usually go unmentioned until they bite. Driving is governed by DVLA rules after a seizure or a brain metastasis and is worth asking about before it is assumed either way. Steroids lift symptoms quickly but have their own effects, and NICE NG122 (1.16.1) says to reduce to the minimum necessary maintenance dose for symptomatic response, so the plan to come down matters as much as the plan to start.","refs":["brain-metastases","dexamethasone","sbrt","osimertinib","lorlatinib","palliative-radiotherapy"],"guideline":{"version":"NICE NG122 (2019, updated March 2024)","url":"https://www.nice.org.uk/guidance/ng122/chapter/Palliative-interventions-and-supportive-and-palliative-care"}},{"setting":"A clinical trial or standard treatment","approach":"Lung cancer has more trials open than almost any other cancer, because the targets keep multiplying, and at several points a trial is a reasonable choice beside standard treatment rather than a last resort. The open questions this record follows are the ones a trial would answer for you: whether immunotherapy before surgery should be continued afterwards and for how long; whether stereotactic radiotherapy matches surgery for a small tumour in someone fit for either, which NICE itself has written as a research recommendation; what to give after a third-generation EGFR inhibitor stops working; whether treating a single growing spot buys more time on the same tablet; and whether preventive brain radiotherapy in small-cell disease can be replaced by regular MRI scans, another NICE research recommendation. The NHS is the plainest source on what taking part involves: you can ask your doctor or a patient organisation about trials you may be eligible to join; you will usually be randomly assigned either to the treatment being assessed or to a control group given standard treatment, or a placebo where no proven standard exists; trials can be time consuming, with screening and follow-up visits and sometimes overnight stays; some cover travel expenses; and you can choose to leave at any point without giving a reason and without it affecting the care you receive. Ask early rather than late, because most trials require you to be well enough to take part.","refs":["multidisciplinary-tumour-board","herthena-lung02","laura","sbrt","liquid-biopsy"],"guideline":{"version":"NICE NG122 (2019, updated March 2024)","url":"https://www.nice.org.uk/guidance/ng122/chapter/Recommendations-for-research"}},{"setting":"When to talk about palliative care","approach":"Palliative care means symptom control and support, and it is not a stage of the illness. In lung cancer this is not an opinion: it is one of the few places in oncology where starting supportive care early was tested in a randomised trial and improved survival. Temel and colleagues (NEJM 2010) randomly assigned 151 people with newly diagnosed metastatic non-small-cell lung cancer to early palliative care integrated with standard oncology care, or to standard oncology care alone. At 12 weeks the early palliative care group had better quality of life (mean FACT-L 98.0 against 91.5, P equals 0.03) and fewer depressive symptoms (16 against 38 percent, P equals 0.01); fewer received aggressive care at the end of life (33 against 54 percent, P equals 0.05), and median survival was longer (11.6 against 8.9 months, P equals 0.02). That result is why the referral is offered alongside treatment rather than after it. NICE NG122 fills in what the service does: palliative radiotherapy as symptoms arise or immediately for people who cannot have curative treatment (1.13.1); radiotherapy, debulking or a stent for an airway that is closing (1.14.2); draining a pleural effusion and talc pleurodesis where that would give lasting benefit (1.15.1 and 1.15.2); breathing control, psychosocial support and coping strategies for breathlessness, delivered by people with expertise in the techniques and available in all care settings (1.15.3 and 1.15.4); opioids such as codeine or morphine to reduce cough (1.15.5); chemotherapy and radiotherapy, and a stent where symptoms are severe, for superior vena cava obstruction (1.15.7 and 1.15.8); dexamethasone for symptomatic brain metastases (1.16.1); single-fraction radiotherapy for bone pain that ordinary painkillers are not controlling (1.17.1); and multidisciplinary management of weight loss, appetite, swallowing and depression (1.18.1). Marie Curie adds that it can start at any point and can run alongside chemotherapy or radiotherapy, and that it also supports the people close to you.","refs":["palliative-care","palliative-radiotherapy","pleurodesis","pleural-effusion","pain-management","psycho-oncology","curative-intent"],"guideline":{"version":"NICE NG122 (2019, updated March 2024)","url":"https://www.nice.org.uk/guidance/ng122/chapter/Palliative-interventions-and-supportive-and-palliative-care"}},{"setting":"Screening for lung cancer in people who have smoked","approach":"Annual low-dose CT of the chest in current and former smokers of the eligible age and pack-year range, with volume-based nodule management. NLST (53,454 participants) showed a 20 percent relative reduction in lung cancer mortality against chest radiography, and NELSON (15,789) a 24 percent reduction in men at ten years with a lower false-positive rate. In England the Targeted Lung Health Check programme invites people aged 55 to 74 with a smoking history. Screening is the single intervention with the largest effect on lung cancer mortality, and uptake, not evidence, is the limiting factor.","refs":["nlst-nelson","low-dose-ct-screening","ct","nhs-galleri"],"guideline":{"version":"NICE NG122; USPSTF; NHS Targeted Lung Health Check","url":"https://www.nice.org.uk/guidance/ng122"}},{"setting":"Stage I non-small-cell lung cancer, fit for surgery","approach":"Anatomical resection with mediastinal lymph node dissection or sampling. For a peripheral tumour 2 cm or smaller, sublobar resection is now a standard option rather than a compromise: JCOG0802/WJOG4607L found segmentectomy superior to lobectomy for overall survival (in the radiologically pure-solid subgroup, five-year overall survival 92.4 against 86.1 percent, hazard ratio 0.64), and CALGB 140503 found sublobar resection non-inferior for disease-free survival in 697 patients. Adjuvant chemotherapy is not given: the LACE pooled analysis found a hazard ratio of 1.40 in stage IA, so it is avoided, and stage IB gains little. Video-assisted or robotic access is preferred where expertise exists.","refs":["jcog0802","calgb-140503","lace-pooled-analysis","robotic-surgery","lobectomy","segmentectomy","minimally-invasive-surgery"],"guideline":{"version":"NICE NG122; NCCN Non-Small Cell Lung Cancer; ESMO","url":"https://www.nccn.org/guidelines/guidelines-detail?category=1&id=1450"}},{"setting":"Stage I non-small-cell lung cancer, not fit for surgery","approach":"Stereotactic ablative radiotherapy, typically 54 Gy in three fractions or an equivalent schedule adapted to tumour position. CHISEL randomised 101 patients with inoperable peripheral stage I disease to stereotactic or conventional radiotherapy and found better local control and overall survival with the stereotactic schedule. Whether it can replace an operation in fit patients is unsettled: the pooled STARS and ROSEL analysis favoured radiotherapy (three-year overall survival 95 against 79 percent), but on 58 patients from two trials that closed early, and the larger randomised comparisons have not reported. Thermal ablation is an alternative for small tumours where radiotherapy is not possible.","refs":["chisel","stars-rosel","sbrt","thermal-ablation"],"guideline":{"version":"NICE NG122; NCCN Non-Small Cell Lung Cancer","url":"https://www.nccn.org/guidelines/guidelines-detail?category=1&id=1450"}},{"setting":"Resected stage II to IIIA non-small-cell lung cancer, adjuvant chemotherapy","approach":"Four cycles of cisplatin with vinorelbine, or another cisplatin doublet, starting six to twelve weeks after surgery. IALT (1,867 patients) gave five-year survival 44.5 against 40.4 percent, JBR.10 established the cisplatin and vinorelbine regimen, and ANITA gave median survival 65.7 against 43.7 months. The LACE pooled analysis of 4,584 patients set the modern indication: hazard ratio 0.89 overall, a 5.4 percent absolute five-year benefit, rising with stage (stage II 0.83, stage III 0.83) and absent, with a point estimate favouring observation, in stage IA. Carboplatin is substituted where cisplatin is contraindicated, on weaker evidence. Postoperative mediastinal radiotherapy is not given for N2 disease after a complete resection: Lung ART did not improve three-year disease-free survival and increased cardiopulmonary toxicity.","refs":["ialt","jbr-10","anita","lace-pooled-analysis","lung-art","cisplatin","vinorelbine","cytotoxic-chemotherapy"],"guideline":{"nccn":"Category 1 (stage II-IIIA)","version":"NICE NG122; NCCN Non-Small Cell Lung Cancer; LACE","url":"https://www.nccn.org/guidelines/guidelines-detail?category=1&id=1450"}},{"setting":"Resected EGFR-mutant or ALK-positive non-small-cell lung cancer, adjuvant targeted therapy","approach":"For an EGFR exon 19 deletion or L858R, osimertinib after resection and any adjuvant chemotherapy. ADAURA improved disease-free and overall survival, and the 2026 exploratory long-term analysis gives eight-year overall survival of 74 against 58 percent in stage II to IIIA (hazard ratio 0.53) and 79 against 64 percent in stage IB to IIIA (0.52), with the benefit larger for exon 19 deletions (0.45) than L858R (0.72). In England NICE TA1043 funds it but requires that it stops at three years. For ALK-positive disease, two years of alectinib after resection of stage IB (4 cm or more) to IIIA disease, on ALINA (disease-free survival hazard ratio 0.24), FDA-approved in 2024; overall survival is immature. Adjuvant immunotherapy is not given alongside either: EGFR- and ALK-altered tumours were excluded from or did not benefit in the immunotherapy trials.","refs":["adaura","alina","osimertinib","alectinib","egfr-exon19-l858r","lung-uk-drug-access"],"guideline":{"version":"NICE TA1043; NCCN Non-Small Cell Lung Cancer","url":"https://www.nice.org.uk/guidance/ta1043"}},{"setting":"Resectable stage II to IIIB non-small-cell lung cancer without a driver, perioperative immunotherapy","approach":"Three or four cycles of platinum doublet chemotherapy with a checkpoint inhibitor before surgery, and in most schedules the checkpoint inhibitor alone for a year afterwards. CheckMate 816 gave neoadjuvant nivolumab with chemotherapy alone (median event-free survival 31.6 against 20.8 months, hazard ratio 0.63; pathological complete response 24.0 against 2.2 percent). The perioperative schedule adds adjuvant treatment: KEYNOTE-671 with pembrolizumab, AEGEAN with durvalumab (event-free survival hazard ratio 0.69), CheckMate 77T with nivolumab (18-month event-free survival 70.2 against 50.0 percent, hazard ratio 0.58), Neotorch with toripalimab in stage III disease (hazard ratio 0.40) and RATIONALE-315 with tislelizumab (overall survival hazard ratio 0.65). Whether the adjuvant half adds anything to the neoadjuvant half is the open question; no trial has tested it directly. Tumours with EGFR or ALK alterations are excluded. Adjuvant-only immunotherapy after chemotherapy remains an option where surgery came first: atezolizumab in PD-L1-positive stage II to IIIA disease (IMpower010) or pembrolizumab (KEYNOTE-091).","refs":["checkmate-816","keynote-671","nct03800134","nct04025879","neotorch","nct04379635","nct02486718","keynote-091","neoadjuvant-adjuvant","pcr","major-pathological-response","efs"],"guideline":{"nccn":"Category 1","version":"NICE TA1127, TA1017, TA1030, TA876, TA1037, TA1071; NCCN","url":"https://www.nice.org.uk/guidance/ta1127"}},{"setting":"Unresectable stage III non-small-cell lung cancer","approach":"Concurrent platinum-based chemoradiotherapy to 60 Gy, then consolidation. RTOG 0617 showed that raising the dose to 74 Gy shortens survival, so 60 Gy is the ceiling. For disease without an EGFR mutation, a year of durvalumab: PACIFIC gave 24-month overall survival 66.3 against 55.6 percent (hazard ratio for death 0.68) and median progression-free survival 17.2 against 5.6 months, with the benefit holding at five years. Concurrent, rather than consolidation, immunotherapy failed in PACIFIC-2. Where chemoradiotherapy had to be given sequentially, GEMSTONE-301 showed consolidation sugemalimab still works (median progression-free survival 9.0 against 5.8 months), although that drug is licensed only in China and the EU. For EGFR-mutant stage III disease, osimertinib instead of durvalumab, on LAURA, funded in England under NICE TA1156.","refs":["pacific","pacific-2","laura","rtog-0617","gemstone-301","durvalumab","osimertinib","chemoradiation","consolidation-therapy"],"guideline":{"nccn":"Category 1","version":"NICE TA798, TA1156; NCCN Non-Small Cell Lung Cancer","url":"https://www.nice.org.uk/guidance/ta798"}},{"setting":"Metastatic non-small-cell lung cancer: what must be tested before treatment","approach":"Comprehensive molecular profiling, by next-generation sequencing of tissue and, where tissue is inadequate or time is short, of plasma, plus PD-L1 immunohistochemistry. The minimum set is EGFR (including exon 20 insertions and the uncommon G719X, L861Q and S768I), ALK, ROS1, KRAS G12C, MET exon 14 skipping, RET, BRAF V600E, HER2 and NTRK, with NRG1 where a targetable fusion is suspected and none is found. Starting immunotherapy before the result is known is the commonest avoidable error: an EGFR- or ALK-driven tumour rarely responds to it, and giving a checkpoint inhibitor shortly before osimertinib raises the risk of severe pneumonitis and hepatotoxicity. PD-L1 assays are not interchangeable: KEYNOTE-024 used 22C3 with a tumour proportion score, IMpower110 used SP142 scoring both tumour and immune cells.","refs":["cgp","liquid-biopsy","pd-l1-testing","tps","companion-diagnostic","driver-mutation","impower110","keynote-024-189"],"guideline":{"version":"NICE NG122; NCCN Non-Small Cell Lung Cancer; ESMO","url":"https://www.nccn.org/guidelines/guidelines-detail?category=1&id=1450"}},{"setting":"Metastatic disease, EGFR exon 19 deletion or L858R","approach":"Osimertinib alone (FLAURA: median progression-free survival 18.9 against 10.2 months, hazard ratio 0.46; median overall survival 38.6 against 31.8 months), or intensified first-line treatment for patients with heavier disease: osimertinib with pemetrexed and platinum chemotherapy (FLAURA2) or amivantamab with lazertinib (MARIPOSA), both funded in England under TA1060 and TA1122. Dacomitinib (ARCHER 1050: 14.7 against 9.2 months against gefitinib) and afatinib (LUX-Lung 3: 13.6 against 6.9 months in the common mutations) remain licensed alternatives. At progression, plasma or tissue is re-tested for MET amplification, C797S, small-cell transformation and other mechanisms; historically T790M after a first-generation drug was treated with osimertinib (AURA3: 10.1 against 4.4 months), a sequence first-line osimertinib has largely removed.","refs":["flaura","flaura2","mariposa","aura3","nct01774721","lux-lung-3","osimertinib","amivantamab","lazertinib","egfr-exon19-l858r","resistance","met-amplification"],"guideline":{"nccn":"Category 1","version":"NICE TA654, TA1060, TA1122; NCCN","url":"https://www.nice.org.uk/guidance/ta654"}},{"setting":"Metastatic disease, EGFR exon 20 insertions and uncommon mutations","approach":"Exon 20 insertions do not respond to osimertinib. First line, amivantamab with carboplatin and pemetrexed (PAPILLON), available in England only through a managed access period under NICE TA1158; amivantamab alone after platinum chemotherapy is approved by the FDA but not recommended by NICE (TA850). Mobocertinib was withdrawn worldwide in 2023 after its confirmatory trial failed. For the non-resistant uncommon mutations G719X, L861Q and S768I, afatinib holds a specific FDA indication granted in January 2018 on a pooled analysis of LUX-Lung 2, 3 and 6, and is preferred to osimertinib.","refs":["nct04538664","amivantamab","afatinib","mobocertinib","egfr-exon20-insertion","egfr-mutation-subtypes","lux-lung-3"],"guideline":{"version":"NICE TA1158, TA850; NCCN Non-Small Cell Lung Cancer","url":"https://www.nice.org.uk/guidance/ta1158"}},{"setting":"Metastatic disease, ALK-positive","approach":"A later-generation ALK inhibitor first, never crizotinib. Lorlatinib has the longest disease control recorded for any targeted lung cancer drug: in CROWN, five-year progression-free survival was 60 against 8 percent with crizotinib (hazard ratio 0.19), with intracranial progression close to abolished, at the cost of neurocognitive, mood, weight and lipid effects. Alectinib (ALEX: median progression-free survival 34.8 against 10.9 months; ALESIA in Asian patients) and brigatinib (ALTA-1L) are the alternatives. Crizotinib, which PROFILE 1014 established against chemotherapy (10.9 against 7.0 months), is now the control arm rather than a treatment. In England NICE funds lorlatinib (TA1103), brigatinib (TA670), alectinib (TA536) and ceritinib (TA500) first line, and lorlatinib (TA628) or brigatinib after crizotinib (TA571) later.","refs":["crown","alex","alesia","j-alex","alta-1l","profile-1014","lorlatinib","alectinib","brigatinib","brain-metastases","gene-fusion"],"guideline":{"nccn":"Category 1","version":"NICE TA1103, TA670, TA536, TA500; NCCN","url":"https://www.nice.org.uk/guidance/ta1103"}},{"setting":"Metastatic disease, ROS1-positive","approach":"Repotrectinib or entrectinib first line, because both cross into the brain. TRIDENT-1 gave a 79 percent response rate and median progression-free survival of 35.7 months in ROS1 inhibitor-naive patients, and responses in 59 percent of those with the G2032R solvent-front mutation after an earlier inhibitor. Crizotinib, which defined the subtype (72 percent response, median progression-free survival 19.2 months in the PROFILE 1001 expansion cohort), penetrates the brain poorly and is a second choice; taletrectinib is approved in China and the United States. In England NICE recommends crizotinib (TA1021) and entrectinib (TA643) and asks for the least expensive; there is no appraisal of repotrectinib for this indication.","refs":["nct03093116","profile-1001-ros1","nct02568267","repotrectinib","entrectinib","crizotinib","taletrectinib","gene-fusion","gatekeeper-mutation"],"guideline":{"version":"NICE TA1021, TA643; NCCN Non-Small Cell Lung Cancer","url":"https://www.nice.org.uk/guidance/ta1021"}},{"setting":"Metastatic disease, KRAS G12C","approach":"Chemotherapy with immunotherapy first line, then a KRAS G12C inhibitor. Sotorasib (CodeBreaK 200) and adagrasib (KRYSTAL-12) both beat docetaxel on progression-free survival in the second line without an overall survival gain, which is why the class is second line rather than first. In England sotorasib is available only through the Cancer Drugs Fund under a managed access agreement (NICE TA781) and adagrasib has no recommendation. Divarasib and olomorasib, which bind the same pocket with better exposure, and the RAS(ON) inhibitors that also cover the non-G12C alleles, are in phase 3. Liver enzyme rises are the characteristic toxicity and are worse when a KRAS inhibitor follows a checkpoint inhibitor closely.","refs":["codebreak-200","krystal-12","codebreak-100","sotorasib","adagrasib","divarasib","olomorasib","kras-inhibitors","hepatotoxicity"],"guideline":{"version":"NICE TA781 (Cancer Drugs Fund); NCCN Non-Small Cell Lung Cancer","url":"https://www.nice.org.uk/guidance/ta781"}},{"setting":"Metastatic disease, MET exon 14 skipping and MET amplification","approach":"Tepotinib or capmatinib for MET exon 14 skipping, on the single-arm VISION and GEOMETRY mono-1 trials; in England NICE TA789 recommends tepotinib and there is no appraisal of capmatinib. Peripheral oedema is the characteristic and often dose-limiting toxicity. For MET-amplified disease arising as resistance to an EGFR inhibitor, savolitinib with osimertinib is approved in China; telisotuzumab vedotin, an antibody-drug conjugate against c-Met, was approved by the FDA in 2025 for previously treated c-Met-high non-squamous disease.","refs":["nct02864992","geometry-mono-1","tepotinib","capmatinib","savolitinib","telisotuzumab-vedotin","met-exon-14-skipping","met-amplification","luminosity"],"guideline":{"version":"NICE TA789; NCCN Non-Small Cell Lung Cancer","url":"https://www.nice.org.uk/guidance/ta789"}},{"setting":"Metastatic disease, RET fusion-positive","approach":"Selpercatinib. LIBRETTO-431 established it against platinum chemotherapy with or without pembrolizumab in untreated disease, and LIBRETTO-001 gave an objective response of 85 percent in the untreated and 64 percent in the previously treated, with 91 percent intracranial response. In England NICE TA911 gives untreated patients access through managed access and TA1042 recommends it routinely after previous treatment. Pralsetinib produced a 61 percent response in the previously treated cohort of ARROW but is not recommended by NICE (TA812), so selpercatinib is effectively the only funded option in England.","refs":["libretto-431","nct03157128","arrow-thyroid","selpercatinib","pralsetinib","gene-fusion","brain-metastases"],"guideline":{"version":"NICE TA911, TA1042; NCCN Non-Small Cell Lung Cancer","url":"https://www.nice.org.uk/guidance/ta1042"}},{"setting":"Metastatic disease, BRAF V600E, HER2-mutant, NTRK and NRG1","approach":"BRAF V600E: dabrafenib with trametinib (64 percent response in the untreated cohort of BRF113928) or encorafenib with binimetinib (PHAROS); both are funded in England first line only, under NICE TA898 and TA1150. HER2 (ERBB2) mutation: trastuzumab deruxtecan at 5.4 mg/kg (DESTINY-Lung02), with interstitial lung disease as the risk that defines the drug, or zongertinib, a HER2-selective tyrosine kinase inhibitor approved by the FDA in 2025 and moved to first line in 2026. NTRK fusion: larotrectinib or entrectinib, tumour-agnostically. NRG1 fusion: zenocutuzumab, which gave a 29 percent response rate in the 93 patients with non-small-cell lung cancer in the eNRGy study and holds FDA accelerated approval from 4 December 2024. None of the HER2, NTRK or NRG1 options has a lung-specific NICE recommendation.","refs":["brf113928","pharos","destiny-lung02","destiny-lung01","nct02912949","navigate","dabrafenib-trametinib","trastuzumab-deruxtecan","zongertinib","zenocutuzumab","larotrectinib","ild","tumour-agnostic"],"guideline":{"version":"NICE TA898, TA1150; NCCN Non-Small Cell Lung Cancer","url":"https://www.nice.org.uk/guidance/ta898"}},{"setting":"Metastatic disease without a driver, PD-L1 tumour proportion score 50 percent or more","approach":"Pembrolizumab alone (KEYNOTE-024), atezolizumab alone (IMpower110: median overall survival 20.2 against 13.1 months in the PD-L1-highest group, hazard ratio 0.59) or cemiplimab alone (EMPOWER-Lung 1), with chemotherapy added where the disease burden is high or a fast response is needed. The threshold matters: CheckMate 026, which used 5 percent, failed outright (progression-free survival hazard ratio 1.15). In England NICE funds pembrolizumab (TA531, stopped at two years), atezolizumab (TA705) and cemiplimab with chemotherapy (TA1165).","refs":["keynote-024-189","impower110","empower-lung-1","keynote-042","checkmate-026","pembrolizumab","atezolizumab","cemiplimab","tps","pd-l1-testing"],"guideline":{"nccn":"Category 1","version":"NICE TA531, TA705, TA1165; NCCN","url":"https://www.nice.org.uk/guidance/ta531"}},{"setting":"Metastatic disease without a driver, PD-L1 below 50 percent","approach":"Platinum doublet chemotherapy with a checkpoint inhibitor: pemetrexed and platinum with pembrolizumab for non-squamous disease (KEYNOTE-189; NICE TA683) or carboplatin and paclitaxel with pembrolizumab for squamous disease (KEYNOTE-407; NICE TA770). Alternatives are atezolizumab with bevacizumab, carboplatin and paclitaxel (IMpower150; NICE TA584), durvalumab with tremelimumab and chemotherapy (POSEIDON: median overall survival 14.0 against 11.7 months, hazard ratio 0.77) and nivolumab with ipilimumab and two cycles of chemotherapy (CheckMate 9LA: 14.1 against 10.7 months, hazard ratio 0.69), the last of which NICE does not recommend (TA724), so it is not routinely funded in England. Where immunotherapy is contraindicated, chemotherapy alone with maintenance pemetrexed in non-squamous disease.","refs":["keynote-024-189","keynote-407","squire","impower150","nct03164616","checkmate-9la","checkmate-227","pembrolizumab","pemetrexed","carboplatin","maintenance-therapy"],"guideline":{"nccn":"Category 1","version":"NICE TA683, TA770, TA584; NCCN","url":"https://www.nice.org.uk/guidance/ta683"}},{"setting":"Metastatic non-small-cell lung cancer, later lines","approach":"Docetaxel, with nintedanib in adenocarcinoma after first-line chemotherapy (LUME-Lung 1: median progression-free survival 3.4 against 2.7 months; NICE TA347), or single-agent chemotherapy. Where a checkpoint inhibitor was not given first line, nivolumab (CheckMate 017: median overall survival 9.2 against 6.0 months; CheckMate 057: 12.2 against 9.4 months), atezolizumab (OAK: 13.8 against 9.6 months) or pembrolizumab in PD-L1-positive disease (KEYNOTE-010: 10.4 against 8.5 months at 2 mg/kg, hazard ratio 0.71) each beat docetaxel. Ramucirumab with docetaxel (REVEL: median overall survival 10.5 against 9.1 months) is licensed but not recommended by NICE (TA403). Antibody-drug conjugates are entering this space: datopotamab deruxtecan holds an FDA approval from 2025 for EGFR-mutant disease after a tyrosine kinase inhibitor and platinum chemotherapy, and patritumab deruxtecan and sacituzumab tirumotecan are in phase 3. Re-treatment with a checkpoint inhibitor after progression on one is not supported by evidence.","refs":["checkmate-017","checkmate-057","oak","keynote-010","revel","lume-lung-1","tropion-lung01","herthena-lung02","docetaxel","nintedanib","ramucirumab","datopotamab-deruxtecan","patritumab-deruxtecan","adc"],"guideline":{"version":"NICE TA655, TA713, TA520, TA347, TA403; NCCN","url":"https://www.nice.org.uk/guidance/ta347"}},{"setting":"Antibody-drug conjugates and bispecific antibodies entering the field","approach":"The two formats that will decide the next five years. Antibody-drug conjugates: datopotamab deruxtecan against TROP2 improved progression-free but not overall survival in TROPION-Lung01 (hazard ratios 0.75 and 0.94) and holds a 2025 FDA approval for EGFR-mutant disease after a tyrosine kinase inhibitor and platinum chemotherapy; patritumab deruxtecan against HER3 improved progression-free survival in HERTHENA-Lung02 (5.8 against 5.4 months, hazard ratio 0.77) without an overall survival gain and its application was withdrawn; telisotuzumab vedotin against c-Met gave a 28.6 percent response rate in LUMINOSITY, 34.6 percent where c-Met expression was high, and was approved by the FDA in 2025; trastuzumab deruxtecan holds the HER2-mutant indication on DESTINY-Lung02. Bispecific antibodies: ivonescimab, which binds PD-1 and VEGF in one molecule, beat pembrolizumab on progression-free survival in HARMONi-2 (hazard ratio 0.51) with a significant overall survival result announced in 2026, and beat chemotherapy after EGFR inhibition in HARMONi-A (7.1 against 4.8 months, hazard ratio 0.46), but its first global trial, HARMONi-3, missed statistical significance for progression-free survival at interim in May 2026; amivantamab, which binds EGFR and MET, is already standard first line with lazertinib; and tarlatamab, which binds DLL3 and CD3, is the first T-cell engager to improve survival in a common solid tumour (DeLLphi-304, overall survival hazard ratio 0.60). None of these regimens is funded in England outside amivantamab with lazertinib, and the pattern to watch is the one TROPION-Lung01 and HERTHENA-Lung02 set: a progression-free survival gain that does not become an overall survival gain.","refs":["tropion-lung01","herthena-lung02","luminosity","harmoni-2","harmoni-3","harmoni-a","dellphi-304","dellphi-305","destiny-lung02","datopotamab-deruxtecan","patritumab-deruxtecan","telisotuzumab-vedotin","ivonescimab","tarlatamab","amivantamab","adc","bispecific-antibody","t-cell-engager"],"guideline":{"version":"No United Kingdom funding outside amivantamab with lazertinib; NCCN lists datopotamab deruxtecan and telisotuzumab vedotin as options after progression","url":"https://www.nccn.org/guidelines/guidelines-detail?category=1&id=1450"}},{"setting":"Limited-stage small-cell lung cancer","approach":"Four cycles of cisplatin with etoposide and concurrent thoracic radiotherapy starting with cycle 1, then consolidation durvalumab for up to two years and, in most patients, prophylactic cranial irradiation. The radiotherapy schedule is 45 Gy twice daily over three weeks (Intergroup 0096: median survival 23 against 19 months, five-year survival 26 against 16 percent, grade 3 oesophagitis 27 against 11 percent) or 66 Gy once daily, which CONVERT found equivalent. ADRIATIC added durvalumab after chemoradiotherapy and gave median overall survival 55.9 against 33.4 months (hazard ratio 0.73, p=0.01), the largest single gain recorded in this disease; NICE TA1099 funds it in England. Prophylactic cranial irradiation rests on the Auperin meta-analysis of 987 patients (three-year survival 20.7 against 15.3 percent, relative risk of death 0.84), qualified by the Japanese trial of Takahashi, which found no benefit when brain MRI surveillance replaced it.","refs":["adriatic","convert","turrisi-intergroup-0096","pci-overview-1999","takahashi-pci","durvalumab","platinum-etoposide","chemoradiation","curative-intent"],"guideline":{"nccn":"Category 1","version":"NICE TA1099; NCCN Small Cell Lung Cancer","url":"https://www.nccn.org/guidelines/guidelines-detail?category=1&id=1462"}},{"setting":"Extensive-stage small-cell lung cancer, first line","approach":"Four to six cycles of platinum and etoposide with a checkpoint inhibitor, continued as maintenance. IMpower133 added atezolizumab (NICE TA638, performance status 0 or 1 only), CASPIAN added durvalumab (NICE TA1041, same restriction) and ASTRUM-005 added serplulimab (NICE TA1167); adebrelimab and benmelstobart are approved in China. IMforte showed that adding lurbinectedin to atezolizumab maintenance prolongs survival, and the FDA converted lurbinectedin's accelerated approval on it. Consolidation thoracic radiotherapy is offered where thoracic disease remains: CREST missed its one-year endpoint (33 against 28 percent, p=0.066) but tripled two-year survival (13 against 3 percent, p=0.004). Prophylactic cranial irradiation is now a discussion rather than a rule, because MRI surveillance is available.","refs":["impower133","caspian","astrum-005","imforte","crest-thoracic-rt","slotman-pci-es-sclc","takahashi-pci","atezolizumab","durvalumab","serplulimab","lurbinectedin","platinum-etoposide"],"guideline":{"nccn":"Category 1","version":"NICE TA638, TA1041, TA1167; NCCN Small Cell Lung Cancer","url":"https://www.nccn.org/guidelines/guidelines-detail?category=1&id=1462"}},{"setting":"Relapsed small-cell lung cancer","approach":"Whether the relapse is platinum-sensitive (more than 90 days, and often more than 180) decides the first choice. Platinum-sensitive relapse is re-treated with platinum and etoposide. Otherwise: tarlatamab, a DLL3 and CD3 bispecific T-cell engager, gave a 40 percent response rate at 10 mg in DeLLphi-301 and beat chemotherapy in DeLLphi-304, with cytokine release syndrome in about half and a mandatory monitored first dose; lurbinectedin gave a 35.2 percent response rate in its basket cohort; topotecan, oral or intravenous, remains the long-standing option. England is restrictive here: NICE TA1091 does not recommend tarlatamab, lurbinectedin has no United Kingdom marketing authorisation, and TA184 recommends oral topotecan only where re-treatment is inappropriate and CAV is contraindicated.","refs":["nct05060016","dellphi-304","dellphi-305","lurbinectedin-basket-sclc","atlantis","tarlatamab","lurbinectedin","topotecan","t-cell-engager"],"guideline":{"version":"NICE TA1091 (not recommended), TA184; NCCN Small Cell Lung Cancer","url":"https://www.nccn.org/guidelines/guidelines-detail?category=1&id=1462"}},{"setting":"Oligometastatic and oligoprogressive disease","approach":"Where metastases are few, local treatment of all of them alongside systemic therapy. SABR-COMET randomised 99 patients with one to five oligometastatic lesions to stereotactic ablative radiotherapy plus standard care or standard care alone and found longer overall survival, with lung primaries well represented. In oncogene-driven disease, a single progressing site during an otherwise effective targeted drug is treated with radiotherapy or surgery and the drug continued, rather than changing line. The evidence is from small randomised trials and the definition of oligometastatic disease is still argued over.","refs":["sabr-comet","sbrt","oligometastatic","oligoprogression","radiosurgery-srs"],"guideline":{"version":"NCCN Non-Small Cell Lung Cancer; ESMO","url":"https://www.nccn.org/guidelines/guidelines-detail?category=1&id=1450"}},{"setting":"Palliation: breathlessness, pleural effusion and a blocked airway","approach":"Breathlessness is treated by cause and by symptom at once: a handheld fan, low-dose oral morphine, a benzodiazepine only where anxiety is prominent, oxygen only where the patient is hypoxic, and a breathlessness service where one exists. A malignant pleural effusion is drained and then either pleurodesed with talc or managed with an indwelling pleural catheter: TIME2 found breathlessness relief identical (24.7 against 24.4 mm on a 100 mm scale, p=0.96) and AMPLE found the catheter reduced total hospital days (10.0 against 12.0, p=0.03), so the choice turns on trapped lung, home support and how much hospital time the patient will accept. An obstructing endobronchial tumour is debulked at rigid bronchoscopy with cryotherapy, argon plasma or laser and held open with an airway stent, then treated with external beam or endobronchial brachytherapy. Superior vena cava obstruction is relieved with an endovascular stent within a day. Early integrated palliative care from diagnosis of incurable disease improves quality of life and mood.","refs":["time2","ample","lung-palliation-breathlessness-effusion-obstruction","palliative-care","brachytherapy","pleural-effusion","palliative-treatment"],"guideline":{"version":"NICE NG122; BTS pleural disease guideline","url":"https://www.nice.org.uk/guidance/ng122"}},{"setting":"Palliation: bone and brain metastases","approach":"A single 8 Gy fraction of radiotherapy for an uncomplicated painful bone metastasis: the Dutch Bone Metastasis Study found response to initial treatment 71 against 73 percent for a multi-fraction course (p=0.84), and retreatment, needed more often after a single fraction, worked in 63 percent. A bisphosphonate or denosumab reduces skeletal events. Spinal cord compression is treated with dexamethasone, same-day whole-spine MRI and surgery or radiotherapy within 24 hours. For one to four brain metastases, stereotactic radiosurgery alone with MRI surveillance: JROSG 99-1 found adding whole-brain radiotherapy did not lengthen life (7.5 against 8.0 months, p=0.42) though it halved twelve-month brain recurrence (46.8 against 76.4 percent), and QUARTZ found whole-brain radiotherapy added nothing to steroids and supportive care in patients unfit for either. In driver-positive disease, the brain-penetrant drug often controls the metastases without radiotherapy.","refs":["dutch-bone-metastasis-study","jrosg-99-1","quartz","crown","denosumab","zoledronic-acid","palliative-radiotherapy","radiosurgery-srs","bone-metastases","brain-metastases"],"guideline":{"version":"NICE NG122; NICE NG59 (metastatic spinal cord compression)","url":"https://www.nice.org.uk/guidance/ng122"}}],"stateOfArt":["Immunotherapy and targeted drugs have doubled or tripled survival in metastatic non-small-cell disease over a decade.","CT screening is recommended in the United States and, since June 2022, across the four UK nations; in Europe it is still mostly not a programme, and uptake is low where it is.","Small-cell lung cancer has gained immunotherapy and the DLL3 T-cell engager tarlatamab after decades without progress."],"history":[{"year":1950,"title":"Smoking is linked to lung cancer","note":"Doll and Hill's case-control study of London hospital patients, published in the British Medical Journal in the same year as Wynder and Graham's American series, found the association that tobacco control has rested on since; the British Doctors Study that followed it ran for fifty years.","refs":[]},{"year":1954,"title":"Doll and Hill follow British doctors forward","note":"The 1950 case-control studies were called artefacts, so a cohort was assembled before anybody was ill and followed to death. Wynder and Graham's 684 proven cases had appeared in JAMA four months before Doll and Hill's BMJ paper.","refs":["paper-doll-hill-mortality-of-doctors-smoking-bmj-1954","paper-wynder-graham-tobacco-bronchiogenic-carcinoma-jama-1950","paper-doll-peto-50-year-doctors-bmj-2004"]},{"year":1995,"title":"Chemotherapy is shown to help, a little","note":"9,387 patients from 52 randomised trials: a 27 percent reduction in the risk of death when chemotherapy was added to supportive care, and 5 percent absolute benefit at five years after surgery.","refs":["paper-nsclc-collaborative-group-chemotherapy-meta-analysis-bmj-1995"]},{"year":1996,"title":"A prevention trial finds harm","note":"CARET gave beta carotene and retinol to 18,314 smokers and asbestos workers and was stopped 21 months early: relative risk of lung cancer 1.28 and of lung cancer death 1.46.","refs":["paper-caret-beta-carotene-retinol-lung-cancer-nejm-1996"]},{"year":1999,"title":"Small-cell lung cancer gets its two advances","note":"Twice-daily thoracic radiotherapy raised five-year survival from 16 to 26 percent in limited-stage disease, and the prophylactic cranial irradiation overview of 987 patients showed treating a brain with no visible disease raises three-year survival from 15.3 to 20.7 percent.","refs":["paper-turrisi-twice-daily-thoracic-radiotherapy-limited-sclc-nejm-1999","paper-auperin-prophylactic-cranial-irradiation-sclc-nejm-1999"]},{"year":2002,"title":"E1594: four chemotherapy regimens, one result","note":"1,207 patients, a 19 percent response rate and a median survival of 7.9 months whichever platinum doublet was used. That was as far as undirected cytotoxic treatment could go, and it is the baseline every entry after it is measured against.","refs":["paper-schiller-ecog-1594-four-chemotherapy-regimens-nejm-2002"]},{"year":2004,"title":"EGFR mutations explain gefitinib responses","refs":["gefitinib"]},{"year":2006,"title":"Median survival passes twelve months","note":"ECOG 4599 added bevacizumab to chemotherapy in 878 patients with non-squamous disease: 12.3 against 10.3 months, with a risk of increased treatment-related deaths.","refs":["paper-sandler-ecog-4599-bevacizumab-nsclc-nejm-2006"]},{"year":2007,"title":"EML4-ALK: the second driver","note":"A small inversion on chromosome 2p, found in 5 of 75 tumours, transformed fibroblasts. Crizotinib, built as a MET inhibitor, gave a 57 percent response rate in 2010 after 1,500 patients were screened to find 82.","refs":["paper-soda-eml4-alk-fusion-nature-2007","paper-kwak-crizotinib-alk-nsclc-nejm-2010"]},{"year":2008,"title":"Histology chooses the drug, and the adjuvant rule is fixed","note":"Pemetrexed beat gemcitabine in adenocarcinoma (12.6 against 10.9 months) and lost in squamous disease (9.4 against 10.8); LACE pooled 4,584 resected patients for a 5.4 percent five-year gain concentrated in stage II and III.","refs":["paper-scagliotti-cisplatin-pemetrexed-histology-jco-2008","paper-lace-adjuvant-cisplatin-pooled-analysis-jco-2008"]},{"year":2009,"title":"IPASS: the biomarker, not the population","note":"1,217 East Asian never-smokers and light former smokers randomised between gefitinib and chemotherapy; the benefit lived entirely in the EGFR-mutant subgroup, and EGFR testing became standard.","refs":["paper-mok-ipass-gefitinib-pulmonary-adenocarcinoma-nejm-2009","paper-lynch-egfr-activating-mutations-gefitinib-nejm-2004","paper-paez-egfr-mutations-gefitinib-science-2004"]},{"year":2011,"title":"The National Lung Screening Trial proves screening works","note":"53,454 Americans aged 55 to 74 with 30 or more pack-years were randomised to three annual low-dose CT scans or chest radiographs: 20.0 percent fewer lung cancer deaths and 6.7 percent fewer deaths from any cause. It also measured the cost: 24.2 percent of CT screens were positive and 96.4 percent of those positives were false.","refs":["ct","low-dose-ct-screening"]},{"year":2011,"title":"Chest radiography is shown to do nothing","note":"PLCO randomised 154,901 people to four annual chest X-rays or usual care: 1,213 lung cancer deaths against 1,230 after 13 years. It is why low-dose computed tomography had to be proved separately.","refs":["paper-plco-chest-radiograph-lung-cancer-mortality-jama-2011","paper-nlst-nejm-2011"]},{"year":2015,"title":"Nivolumab approved: immunotherapy enters lung cancer","refs":["nivolumab"]},{"year":2017,"title":"Stage III moves, and so does the way tumours are read","note":"PACIFIC put durvalumab after chemoradiotherapy, reaching 42.9 percent five-year survival against 33.4; ALEX moved first-line ALK treatment to a brain-penetrant drug; TRACERx showed copy-number heterogeneity carries a hazard ratio of 4.9 for recurrence or death.","refs":["paper-spigel-pacific-five-year-survival-jco-2022","paper-peters-alex-alectinib-crizotinib-nejm-2017","paper-tracerx-100-nejm-2017","paper-abbosh-phylogenetic-ctdna-lung-cancer-nature-2017"]},{"year":2019,"title":"England starts the Targeted Lung Health Check programme","note":"Mobile CT scanners parked in supermarket car parks in the areas with the highest lung cancer rates, inviting ever-smokers aged 55 to 74 through their GP records and scanning those a risk model placed above threshold. The first phase invited about 900,000 people and found more than 2,000 cancers, 76 percent of them early stage against 29 percent outside the programme.","refs":["nhs-targeted-lung-health-check","targeted-lung-health-check"]},{"year":2020,"title":"NELSON confirms the mortality benefit in Europe","note":"Volume CT at baseline and years 1, 3 and 5.5 in 13,195 men and 2,594 women aged 50 to 74 in the Netherlands and Belgium: a lung cancer death rate ratio of 0.76 at ten years in men and 0.67 in women, with only 2.1 percent referred for a suspicious nodule, a tenth of the American false-positive burden.","refs":["low-dose-ct-screening"]},{"year":2021,"title":"WHO's fifth edition reclassifies lung tumours","note":"The 2021 WHO Classification of Thoracic Tumours added a chapter on classifying small diagnostic samples, graded invasive non-mucinous adenocarcinoma by growth pattern, recognised spread through air spaces and thoracic SMARCA4-deficient undifferentiated tumour, and moved lymphoepithelial carcinoma into the squamous cell carcinomas.","refs":[]},{"year":2021,"title":"Screening widens, and adjuvant immunotherapy arrives","note":"The United States task force lowered eligibility to age 50 and 20 pack-years, two years after Aldrich showed 31 percent of white smokers qualified against 17 percent of Black smokers; IMpower010 showed adjuvant atezolizumab delays recurrence, mainly in PD-L1-positive stage II to IIIA disease.","refs":["paper-uspstf-lung-cancer-screening-jama-2021","paper-aldrich-uspstf-screening-african-american-smokers-jama-oncol-2019","paper-felip-impower010-adjuvant-atezolizumab-lancet-2021"]},{"year":2022,"title":"The UK National Screening Committee recommends targeted screening","note":"After an evidence review and a health economic model, the committee recommended in June 2022 that all four UK nations move towards targeted lung cancer screening at 55 to 74 with integrated smoking cessation, and named the Targeted Lung Health Check programme as a feasible starting point.","refs":[]},{"year":2023,"title":"England announces a national lung cancer screening programme","note":"Announced on 26 June 2023 at a cost of £270 million a year once fully implemented, expected to deliver almost one million scans and find as many as 9,000 cancers a year, using GP records to identify ever-smokers aged 55 to 74 and a risk model to decide who is scanned every two years.","refs":["nhs-targeted-lung-health-check"]},{"year":2023,"title":"Air pollution gets a mechanism, and first-line treatment is intensified","note":"PM2.5 was shown to promote rather than initiate EGFR-driven lung cancer, with oncogenic EGFR mutations in 18 percent of histologically normal lungs; FLAURA2 and AEGEAN reported, and tarlatamab gave a 40 percent response rate in twice-treated small-cell disease.","refs":["paper-hill-lung-adenocarcinoma-air-pollutants-nature-2023","paper-planchard-flaura2-osimertinib-chemotherapy-nejm-2023","paper-heymach-aegean-perioperative-durvalumab-nejm-2023","paper-dellphi-301-nejm-2023"]},{"year":2024,"title":"Tarlatamab: first targeted drug for small-cell lung cancer","refs":["tarlatamab"]},{"year":2024,"title":"Genotype reaches the operating theatre and stage III","note":"ALINA gave adjuvant alectinib after resection of ALK-positive disease (93.8 against 63.0 percent disease-free at two years), LAURA gave osimertinib after chemoradiotherapy in EGFR-mutant stage III (39.1 against 5.6 months), MARIPOSA beat osimertinib in first line, and ADRIATIC lifted limited-stage small-cell survival from 33.4 to 55.9 months.","refs":["paper-wu-alina-adjuvant-alectinib-nejm-2024","paper-lu-laura-osimertinib-stage-iii-nejm-2024","paper-mariposa-nejm-2024","paper-adriatic-nejm-2024"]},{"year":2025,"title":"TNM 9 comes into force","note":"From 1 January 2025 lung cancer is staged by the ninth edition: the T descriptors unchanged, N2 split into N2a and N2b by the number of mediastinal stations involved, M1c split into M1c1 and M1c2 by the number of organ systems, and the stage groups moved to follow (T1N1 to IIA, T1N2a to IIB, T3N2a to IIIA, T2aN2b and T2bN2b to IIIB).","refs":["tnm-9-lung-cancer","tnm-staging"]},{"year":2026,"title":"Five years of the NHS England programme reported","note":"Over two million people invited and 7,193 lung cancers diagnosed to March 2025, 63.1 percent at stage 1 and 12.6 percent at stage 2, with the early-stage share of all lung cancer in England rising over the five years and rising most in the most deprived regions. Full national coverage is expected in 2030.","refs":["nhs-targeted-lung-health-check"]},{"year":2032,"title":"The perioperative and first-line trials complete","note":"ADRIATIC's study completion is listed for 23 October 2026, IMpower010 for 31 August 2027, FLAURA2 for 30 September 2027, LAURA for 29 October 2027, MARIPOSA for 16 February 2028, DeLLphi-304 for 26 March 2028, AEGEAN for 11 September 2028, CROWN for 31 December 2028 and ALINA for 19 November 2031; TRACERx runs to November 2035.","refs":["lung-cancer-evidence-roadmap","alina","crown","mariposa"]}],"pipeline":["tarlatamab","datopotamab-deruxtecan","idea-lung-screening-eligibility-by-risk-not-pack-years","idea-lung-never-smoker-disease-its-own-programme","idea-lung-resistance-directed-sequencing-at-every-progression","idea-lung-brain-metastasis-prevention-as-a-primary-endpoint","idea-lung-deprivation-gradient-treated-as-a-defect-in-delivery","idea-lung-small-cell-platform-with-shared-controls-and-subtypes","idea-lung-uk-screening-testing-and-access-gaps"],"openProblems":["Most of the world's lung cancer is in countries with no screening. Asia carries 65.6 percent of cases and 64.3 percent of deaths (GLOBOCAN 2024), and of the ten European countries surveyed in 2026 only three had a formal programme. A screening benefit demonstrated in the Netherlands and the United States has to be re-earned in each health system that tries to deliver it.","The risk models that select people for screening cannot see never-smokers. Fifteen percent of UK lung cancers, and 15 to 25 percent worldwide, arise in people who have never smoked, and every eligibility rule in use starts from smoking history. Nothing currently offered would find those cancers early.","Overdiagnosis has never been measured well enough to quote. Estimates across the trials range from 0 to 67 percent (US Preventive Services Task Force evidence report, 2021), which is the widest range for any screened cancer, and the number decides how much of the screening benefit is real.","Deprivation drives both the disease and the outcome. UK lung cancer mortality is 102 percent higher in women and 93 percent higher in men in the most deprived fifth than in the least, around 13,400 UK deaths a year are linked with deprivation, and five-year survival in England is 20.1 percent in the most deprived group against 27.6 percent in the least. Screening programmes sited in deprived areas narrow the first gap and may widen the second if uptake does not follow.","Screening eligibility is written in pack-years, which excludes high-risk groups systematically: 31 percent of white smokers qualified against 17 percent of Black smokers in one United States cohort (Aldrich 2019), so a rule built to find the highest risk misses hardest where the risk is highest.","Resistance arrives within one to three years for every targeted drug and is a heterogeneous set of diagnoses, including transformation into small-cell lung cancer in about one in seven, yet most patients move to the next line without a re-biopsy or a plasma profile to say what the tumour became.","Four perioperative immunotherapy schedules (before surgery, after surgery, on both sides, and with chemotherapy) are all standard somewhere and none has been compared with another, so nobody knows which one to choose or whether the adjuvant half adds anything.","Brain metastases are the dominant failure pattern in driver-positive disease and the newest inhibitors appear to prevent them, but prevention is measured as a secondary endpoint on inconsistent imaging schedules, so the size of the effect is unknown.","Extensive-stage small-cell lung cancer gained two to three months of median survival from immunotherapy and still has no predictive biomarker; the four transcription-factor subtypes that might supply one have never been used prospectively to assign treatment.","At the same stage and in systems free at the point of use, patients in more deprived circumstances are less likely to receive any lung cancer treatment (odds ratio 0.79), less likely to have surgery and less likely to have chemotherapy."],"basics":{"symptoms":["A cough that is not going away, shortness of breath, coughing up blood, chest or shoulder pain, repeated chest infections or one that will not clear, losing weight without trying, loss of appetite, feeling tired all the time (NHS)","Less common: swelling of the face or neck, difficulty swallowing, a hoarse voice that does not go away, finger clubbing where the fingertips look wider or curve downwards (NHS)","Early lung cancer often causes no symptoms at all, which is why screening finds cancers that presentation does not (NHS)","See a GP for a cough lasting longer than 3 weeks or any other symptom; ask for an urgent GP appointment or use NHS 111 if you cough up blood; call 999 or go to A&E if you are struggling to breathe or have pain in the chest or upper back (NHS)","GP referral rules (NICE NG12 1.1.1 to 1.1.3): suspected cancer pathway referral for chest X-ray findings suggesting lung cancer or unexplained haemoptysis at 40 and over; urgent direct access chest X-ray at 40 and over for two or more of cough, fatigue, shortness of breath, chest pain, weight loss and appetite loss, or one of them in anyone who has ever smoked; consider an urgent chest X-ray for persistent or recurrent chest infection, finger clubbing, supraclavicular or persistent cervical lymphadenopathy, chest signs consistent with lung cancer, or thrombocytosis","In England in 2019, about 26 percent of lung cancers were diagnosed after an urgent suspected cancer referral and 33 percent after an emergency presentation (Cancer Research UK)"],"diagnosis":["Chest X-ray first in primary care; contrast-enhanced CT of the chest, liver, adrenals and lower neck before any biopsy (NICE NG122 1.2.2, 1.2.14)","PET-CT for everyone who could have treatment with curative intent (NICE NG122 1.2.4)","Mediastinal nodes sampled through the airway or oesophageal wall by endobronchial ultrasound-guided needle aspiration, endoscopic ultrasound-guided needle aspiration, or both, with surgical staging kept for a negative result and continuing suspicion (NICE NG122 1.2.8, 1.2.20 to 1.2.22)","Brain imaging by stage: none for clinical stage 1 without neurological symptoms, contrast-enhanced CT for stage 2, contrast-enhanced MRI for stage 3 (NICE NG122 1.2.24 to 1.2.26)","The biopsy must be big enough for subtyping and molecular markers; the panel is set by the National Genomics Test Directory (NICE NG122 1.2.11, 1.2.12)"],"staging":["The ninth edition of the TNM classification has been in force since 1 January 2025, built on 124,581 patients diagnosed from 2011 to 2019 (British Journal of Radiology 2025; IASLC staging project)","T descriptors are unchanged from the eighth edition: the T subcommittee tested them against the new database and proposed no change","N changed: N2 is split into N2a, a single ipsilateral mediastinal or subcarinal station, and N2b, multiple ipsilateral mediastinal stations with or without the subcarinal station","M changed at the far end: M1c is split into M1c1, several metastases in one extrathoracic organ system, and M1c2, several metastases across organ systems; both remain stage IVB","Stage groups moved to follow: T1N1 to IIA, T1N2a to IIB, T3N2a to IIIA, T2aN2b and T2bN2b to IIIB","Small-cell lung cancer is also staged by TNM, and the older limited and extensive stage labels are still used alongside it because they decide whether radiotherapy is given to the chest","In England 34 percent of staged cases in 2022 were stage I or II; in the United States 24 percent are localised at diagnosis, 21 percent regional and 51 percent distant (Cancer Research UK; SEER)"],"sources":[]},"prognosis":{"text":"Population averages for the whole family, not a personal prognosis, and they lag the treatments now in use. In the United States 29.5 percent of people diagnosed with lung and bronchus cancer in 2016 to 2022 were alive five years later relative to people of the same age without the disease; by stage that is 65.5 percent for localised disease, which is 24 percent of cases, 38.2 percent for regional (21 percent), 10.5 percent for distant (51 percent) and 17.5 percent for unstaged (4 percent) (SEER). In the UK 11.1 percent of people are predicted to survive ten years or more, against 3.3 percent in the 1970s, and 18.1 percent of people diagnosed in England survive five years, rising to 43.5 percent among those who have already survived a year. Survival is higher in women than men and falls steeply with age, from 32.7 percent of women and 22.2 percent of men diagnosed at 15 to 44 to 9.2 percent of women and 5.2 percent of men diagnosed at 75 to 99, and it tracks deprivation: 20.1 percent at five years in the most deprived group in England against 27.6 percent in the least (Cancer Research UK). The averages differ sharply by type, which is why each type page carries its own.","sources":[{"label":"SEER Cancer Stat Facts: lung and bronchus cancer (rates, stage distribution, survival by stage, age and race)","url":"https://seer.cancer.gov/statfacts/html/lungb.html"},{"label":"CRUK: lung cancer survival statistics (by age, deprivation and over time)","url":"https://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/lung-cancer/survival"}]}},"route":"/cancers/lung-cancer/","neighbours":{"cancer":[{"id":"lung-adenocarcinoma","kind":"cancer","name":"Adenocarcinoma of the lung","route":"/cancers/lung-adenocarcinoma/"},{"id":"pleuropulmonary-blastoma","kind":"cancer","name":"Childhood lung and airway tumours (pleuropulmonary blastoma, tracheobronchial tumours)","route":"/cancers/pleuropulmonary-blastoma/"},{"id":"lung-lcnec","kind":"cancer","name":"Large cell neuroendocrine carcinoma of the lung","route":"/cancers/lung-lcnec/"},{"id":"lung-net","kind":"cancer","name":"Lung neuroendocrine tumours (typical and atypical carcinoid)","route":"/cancers/lung-net/"},{"id":"mesothelioma","kind":"cancer","name":"Mesothelioma","route":"/cancers/mesothelioma/"},{"id":"nsclc","kind":"cancer","name":"Non-small-cell lung cancer","route":"/cancers/nsclc/"},{"id":"sclc","kind":"cancer","name":"Small-cell lung cancer","route":"/cancers/sclc/"},{"id":"lung-squamous-cell-carcinoma","kind":"cancer","name":"Squamous cell carcinoma of the lung","route":"/cancers/lung-squamous-cell-carcinoma/"}],"roadmap":[{"id":"prevention-roadmap","kind":"roadmap","name":"Cancer prevention roadmap: tobacco control and vaccines → biomarker-guided chemoprevention → interception in carriers","route":"/roadmaps/prevention-roadmap/"},{"id":"early-detection-roadmap","kind":"roadmap","name":"Early detection roadmap: organ screening → blood tests for many cancers","route":"/roadmaps/early-detection-roadmap/"},{"id":"lung-cancer-evidence-roadmap","kind":"roadmap","name":"Lung cancer roadmap: from Doll and Hill and the naming of tobacco, through the cytotoxic plateau, computed tomography screening, EGFR and ALK, immunotherapy by PD-L1, the perioperative trials and PACIFIC, to DLL3 in small-cell disease and a 2032 registry watch","route":"/roadmaps/lung-cancer-evidence-roadmap/"}],"idea":[{"id":"idea-lung-screening-eligibility-by-risk-not-pack-years","kind":"idea","name":"Decide who is screened for lung cancer by individual risk, not by pack-years","route":"/ideas/idea-lung-screening-eligibility-by-risk-not-pack-years/"},{"id":"idea-lung-resistance-directed-sequencing-at-every-progression","kind":"idea","name":"Make resistance a diagnosis: sequence at every progression and choose the next line from what the tumour became","route":"/ideas/idea-lung-resistance-directed-sequencing-at-every-progression/"},{"id":"idea-lung-brain-metastasis-prevention-as-a-primary-endpoint","kind":"idea","name":"Measure brain metastasis prevention as a primary endpoint, not as a secondary one","route":"/ideas/idea-lung-brain-metastasis-prevention-as-a-primary-endpoint/"},{"id":"idea-lung-uk-screening-testing-and-access-gaps","kind":"idea","name":"Publish the four numbers the NHS lung cancer pathway does not currently measure: reflex testing rate, genomic turnaround, surgical access and a lung-specific waiting time in every nation","route":"/ideas/idea-lung-uk-screening-testing-and-access-gaps/"},{"id":"idea-lung-small-cell-platform-with-shared-controls-and-subtypes","kind":"idea","name":"Run small-cell lung cancer as one platform with shared controls and subtype stratification","route":"/ideas/idea-lung-small-cell-platform-with-shared-controls-and-subtypes/"},{"id":"idea-lung-never-smoker-disease-its-own-programme","kind":"idea","name":"Treat lung cancer in never-smokers as its own disease, with its own detection programme","route":"/ideas/idea-lung-never-smoker-disease-its-own-programme/"},{"id":"idea-lung-deprivation-gradient-treated-as-a-defect-in-delivery","kind":"idea","name":"Treat the deprivation gradient in lung cancer as a defect in delivery that can be fixed and measured","route":"/ideas/idea-lung-deprivation-gradient-treated-as-a-defect-in-delivery/"}],"technology":[{"id":"adc","kind":"technology","name":"Antibody-drug conjugate (ADC)","route":"/technologies/adc/"},{"id":"bispecific-antibody","kind":"technology","name":"Bispecific antibodies","route":"/technologies/bispecific-antibody/"},{"id":"brachytherapy","kind":"technology","name":"Brachytherapy","route":"/technologies/brachytherapy/"},{"id":"pain-management","kind":"technology","name":"Cancer pain management","route":"/technologies/pain-management/"},{"id":"cbt-fatigue-distress","kind":"technology","name":"Cognitive behavioural therapy for fatigue and distress","route":"/technologies/cbt-fatigue-distress/"},{"id":"companion-diagnostic","kind":"technology","name":"Companion diagnostics","route":"/technologies/companion-diagnostic/"},{"id":"cgp","kind":"technology","name":"Comprehensive genomic profiling","route":"/technologies/cgp/"},{"id":"ct","kind":"technology","name":"CT (computed tomography)","route":"/technologies/ct/"},{"id":"cytotoxic-chemotherapy","kind":"technology","name":"Cytotoxic chemotherapy","route":"/technologies/cytotoxic-chemotherapy/"},{"id":"palliative-care","kind":"technology","name":"Early integrated palliative care","route":"/technologies/palliative-care/"},{"id":"eras-perioperative-nutrition","kind":"technology","name":"Enhanced recovery (ERAS) and perioperative nutrition","route":"/technologies/eras-perioperative-nutrition/"},{"id":"exercise-during-chemotherapy","kind":"technology","name":"Exercise during chemotherapy and radiotherapy","route":"/technologies/exercise-during-chemotherapy/"},{"id":"financial-navigation","kind":"technology","name":"Financial toxicity and financial navigation","route":"/technologies/financial-navigation/"},{"id":"germline-testing","kind":"technology","name":"Germline (hereditary) testing","route":"/technologies/germline-testing/"},{"id":"histopathology-ihc","kind":"technology","name":"Histopathology & immunohistochemistry","route":"/technologies/histopathology-ihc/"},{"id":"checkpoint-inhibitor","kind":"technology","name":"Immune checkpoint inhibitors","route":"/technologies/checkpoint-inhibitor/"},{"id":"imrt-igrt","kind":"technology","name":"IMRT / IGRT (modern external beam)","route":"/technologies/imrt-igrt/"},{"id":"kras-inhibitors","kind":"technology","name":"KRAS & RAS inhibitors","route":"/technologies/kras-inhibitors/"},{"id":"liquid-biopsy","kind":"technology","name":"Liquid biopsy (ctDNA)","route":"/technologies/liquid-biopsy/"},{"id":"low-dose-ct-screening","kind":"technology","name":"Low-dose CT lung screening","route":"/technologies/low-dose-ct-screening/"},{"id":"multidisciplinary-tumour-board","kind":"technology","name":"Multidisciplinary tumour boards","route":"/technologies/multidisciplinary-tumour-board/"},{"id":"nhs-targeted-lung-health-check","kind":"technology","name":"NHS Targeted Lung Health Check (lung cancer screening programme)","route":"/technologies/nhs-targeted-lung-health-check/"},{"id":"oncology-nutrition","kind":"technology","name":"Nutrition support and cachexia management","route":"/technologies/oncology-nutrition/"},{"id":"palliative-radiotherapy","kind":"technology","name":"Palliative radiotherapy","route":"/technologies/palliative-radiotherapy/"},{"id":"peer-support-groups","kind":"technology","name":"Peer support and support groups","route":"/technologies/peer-support-groups/"},{"id":"pet","kind":"technology","name":"PET (positron emission tomography)","route":"/technologies/pet/"},{"id":"pet-ct","kind":"technology","name":"PET/CT","route":"/technologies/pet-ct/"},{"id":"photodynamic-therapy-lasers","kind":"technology","name":"Photodynamic therapy lasers and light sources","route":"/technologies/photodynamic-therapy-lasers/"},{"id":"prehabilitation","kind":"technology","name":"Prehabilitation before cancer surgery","route":"/technologies/prehabilitation/"},{"id":"prophylactic-cranial-irradiation","kind":"technology","name":"Prophylactic cranial irradiation vs MRI surveillance","route":"/technologies/prophylactic-cranial-irradiation/"},{"id":"psycho-oncology","kind":"technology","name":"Psycho-oncology and distress screening","route":"/technologies/psycho-oncology/"},{"id":"robotic-surgery","kind":"technology","name":"Robotic & minimally invasive surgery","route":"/technologies/robotic-surgery/"},{"id":"sbrt","kind":"technology","name":"SBRT / SABR (stereotactic radiotherapy)","route":"/technologies/sbrt/"},{"id":"kinase-inhibitors","kind":"technology","name":"Small-molecule kinase inhibitors","route":"/technologies/kinase-inhibitors/"},{"id":"radiosurgery-srs","kind":"technology","name":"Stereotactic radiosurgery (Gamma Knife, CyberKnife, linac SRS)","route":"/technologies/radiosurgery-srs/"},{"id":"survivorship-care-plan","kind":"technology","name":"Survivorship care and late-effects surveillance","route":"/technologies/survivorship-care-plan/"},{"id":"t-cell-engager","kind":"technology","name":"T-cell engagers (bispecific)","route":"/technologies/t-cell-engager/"},{"id":"thermal-ablation","kind":"technology","name":"Thermal ablation (RFA, microwave, cryo)","route":"/technologies/thermal-ablation/"},{"id":"wes-wgs","kind":"technology","name":"Whole-exome & whole-genome sequencing","route":"/technologies/wes-wgs/"},{"id":"x-ray-radiography-fluoroscopy","kind":"technology","name":"X-ray radiography and fluoroscopy","route":"/technologies/x-ray-radiography-fluoroscopy/"}],"term":[{"id":"rejuv-second-age-smoking-and-inherited-risk","kind":"term","name":"Age, smoking and inherited predisposition: what the treatment risk is added to","route":"/terms/rejuv-second-age-smoking-and-inherited-risk/"},{"id":"anaemia","kind":"term","name":"Anaemia","route":"/terms/anaemia/"},{"id":"asbestos","kind":"term","name":"Asbestos","route":"/terms/asbestos/"},{"id":"bone-metastases","kind":"term","name":"Bone metastases and skeletal-related events","route":"/terms/bone-metastases/"},{"id":"brain-metastases","kind":"term","name":"Brain metastases (intracranial disease)","route":"/terms/brain-metastases/"},{"id":"bronchoscopy","kind":"term","name":"Bronchoscopy (EBUS, robotic navigation)","route":"/terms/bronchoscopy/"},{"id":"cachexia","kind":"term","name":"Cancer cachexia","route":"/terms/cachexia/"},{"id":"cancer-related-fatigue","kind":"term","name":"Cancer-related fatigue (tiredness)","route":"/terms/cancer-related-fatigue/"},{"id":"chemoradiation","kind":"term","name":"Chemoradiation (chemoradiotherapy, CRT)","route":"/terms/chemoradiation/"},{"id":"ctdna","kind":"term","name":"Circulating tumour DNA (ctDNA)","route":"/terms/ctdna/"},{"id":"consolidation-therapy","kind":"term","name":"Consolidation therapy","route":"/terms/consolidation-therapy/"},{"id":"curative-intent","kind":"term","name":"Curative intent vs palliative intent","route":"/terms/curative-intent/"},{"id":"driver-mutation","kind":"term","name":"Driver mutation","route":"/terms/driver-mutation/"},{"id":"resistance","kind":"term","name":"Drug resistance (primary and acquired)","route":"/terms/resistance/"},{"id":"egfr-exon19-l858r","kind":"term","name":"EGFR exon 19 deletion & L858R","route":"/terms/egfr-exon19-l858r/"},{"id":"egfr-exon20-insertion","kind":"term","name":"EGFR exon 20 insertion","route":"/terms/egfr-exon20-insertion/"},{"id":"egfr-mutation-subtypes","kind":"term","name":"EGFR mutation subtypes (exon 19 deletion, L858R, exon 20 insertion, T790M)","route":"/terms/egfr-mutation-subtypes/"},{"id":"ebus-tbna","kind":"term","name":"Endobronchial ultrasound (EBUS-TBNA)","route":"/terms/ebus-tbna/"},{"id":"efs","kind":"term","name":"Event-free / disease-free survival (EFS, DFS, iDFS, RFS)","route":"/terms/efs/"},{"id":"febrile-neutropenia","kind":"term","name":"Febrile neutropenia","route":"/terms/febrile-neutropenia/"},{"id":"fish","kind":"term","name":"FISH / ISH (in situ hybridisation)","route":"/terms/fish/"},{"id":"gene-fusion","kind":"term","name":"Gene fusion","route":"/terms/gene-fusion/"},{"id":"haemoptysis","kind":"term","name":"Haemoptysis (coughing up blood)","route":"/terms/haemoptysis/"},{"id":"hepatotoxicity","kind":"term","name":"Hepatotoxicity (liver enzyme elevation)","route":"/terms/hepatotoxicity/"},{"id":"histology","kind":"term","name":"Histology","route":"/terms/histology/"},{"id":"immune-colitis","kind":"term","name":"Immune-mediated colitis and diarrhoea","route":"/terms/immune-colitis/"},{"id":"irae","kind":"term","name":"Immune-related adverse events (irAEs)","route":"/terms/irae/"},{"id":"ihc","kind":"term","name":"Immunohistochemistry (IHC)","route":"/terms/ihc/"},{"id":"ild","kind":"term","name":"Interstitial lung disease (ILD) / pneumonitis","route":"/terms/ild/"},{"id":"late-effects","kind":"term","name":"Late effects and survivorship 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