What changed: Lung cancer (all types)

When this page itself was last checked or edited.

Untreated advanced EGFR mutation-positive non-small-cell lung cancer (exon 19 deletion or L858R), with lazertinib

Untreated advanced non-small-cell lung cancer with an activating EGFR exon 20 insertion, with carboplatin and pemetrexed

Untreated locally advanced non-small-cell lung cancer unsuitable for definitive chemoradiation, or metastatic disease, with PD-L1 in 1 percent or more of tumour cells and no EGFR or ALK alteration, with platinum-based chemotherapy

Untreated advanced EGFR mutation-positive non-small-cell lung cancer (exon 19 deletion or L858R), with amivantamab

Resectable non-small-cell lung cancer at high risk of recurrence without an EGFR mutation or ALK rearrangement: neoadjuvant with platinum chemotherapy then adjuvant alone

Unresectable stage III EGFR mutation-positive non-small-cell lung cancer that has not progressed after platinum-based chemoradiotherapy

Untreated extensive-stage small-cell lung cancer, with carboplatin and etoposide

Objective response 64 percent after platinum chemotherapy and 85 percent in previously untreated RET fusion-positive non-small-cell lung cancer; intracranial response 91 percent.

At the final analysis (median follow-up 38.

Met the primary overall survival endpoint at the pre-specified interim analysis (Amgen, 8 September 2026); progression-free survival and response rate also improved; figures not yet disclosed.

Interim PFS not statistically significant (May 2026); final readouts pending.

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.

Adjuvant treatment of resected non-small-cell lung cancer after platinum chemotherapy, where PD-L1 is on 50 percent or more of tumour cells and the tumour is not EGFR-mutant or ALK-positive

Untreated extensive-stage small-cell lung cancer, with etoposide and either carboplatin or cisplatin

Resectable non-small-cell lung cancer (4 cm or more, or node positive) without an EGFR mutation or ALK rearrangement, neoadjuvant with platinum chemotherapy then adjuvant alone

Limited-stage small-cell lung cancer that has not progressed after platinum-based chemoradiotherapy

ALK-positive advanced non-small-cell lung cancer not previously treated with an ALK inhibitor

Adjuvant treatment of stage IB to IIIA EGFR exon 19 deletion or L858R non-small-cell lung cancer after complete resection

Untreated advanced EGFR mutation-positive non-small-cell lung cancer, with pemetrexed and platinum-based chemotherapy

Adjuvant treatment of non-small-cell lung cancer at high risk of recurrence after complete resection and platinum chemotherapy

Previously treated RET fusion-positive advanced non-small-cell lung cancer not previously treated with a RET inhibitor

Extensive-stage small-cell lung cancer progressing after two or more lines of treatment including platinum-based chemotherapy: not recommended

Objective response 30 percent across 158 evaluable NRG1 fusion-positive cancers, 42 percent (15 of 36) in pancreatic cancer; median duration of response 11.

OS HR 0.

PFS HR 0.

OS 13.

261 lung cancers in 12,773 participants, 79.

PLCOm2012 at 1.

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).

ROS1-positive advanced non-small-cell lung cancer in patients who have not had a ROS1 inhibitor

Resectable non-small-cell lung cancer at high risk of recurrence, neoadjuvant with platinum chemotherapy then adjuvant alone

Eighteen-month event-free survival 70.

Repotrectinib produced responses in 79 percent of ROS1 inhibitor-naive patients (median progression-free survival 35.

OS 55.

PFS HR 0.

PFS 7.

PFS HR 0.

PFS HR 0.

ORR 28.

Median event-free survival not estimable against 15.

Concurrent durvalumab with chemoradiotherapy did not significantly improve progression-free survival over chemoradiotherapy alone.

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.

A milestone in how this cancer is treated.

BRAF V600 mutation-positive advanced non-small-cell lung cancer, first line only

Neoadjuvant treatment of resectable non-small-cell lung cancer (4 cm or more, or node positive), with chemotherapy

Untreated RET fusion-positive advanced non-small-cell lung cancer

Objective response 40 percent at the 10 mg dose and 32 percent at 100 mg in previously treated small-cell lung cancer; median progression-free survival 4.

Perioperative durvalumab with neoadjuvant platinum chemotherapy improved event-free survival (hazard ratio 0.

DFS HR 0.

5-year disease-free survival 63.

Objective response 21 percent (8 of 38; 95 percent confidence interval 10 to 37); median progression-free survival 4.

Confirmed response rate 49.

PFS HR 0.

EFS HR 0.

PFS HR 0.

PFS HR 0.

Response rate 75% (treatment-naive, n=59) and 46% (previously treated, n=39); FDA approval October 2023.

Copy-number heterogeneity predicted recurrence or death with a hazard ratio of 4.

PFS HR 0.

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.

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.

Locally advanced or metastatic non-small-cell lung cancer with an EGFR exon 20 insertion after platinum-based chemotherapy: not recommended

Locally advanced unresectable non-small-cell lung cancer with PD-L1 on 1 percent or more of cells that has not progressed after concurrent platinum-based chemoradiation

Untreated metastatic squamous non-small-cell lung cancer, with carboplatin and paclitaxel

RET fusion-positive advanced non-small-cell lung cancer in patients who have not had a RET inhibitor: not recommended

KRAS G12C mutation-positive locally advanced or metastatic non-small-cell lung cancer that has progressed on, or after intolerance of, platinum-based chemotherapy or PD-1/PD-L1 immunotherapy

Advanced non-small-cell lung cancer with MET exon 14 skipping alterations

OS 15.

EFS HR 0.

PFS HR 0.

High response rate with durable responses in HER2-mutant non-small-cell lung cancer; accelerated approval in August 2022.

Median progression-free survival 9.

Segmentectomy was superior to lobectomy for overall survival; in the pure-solid subgroup five-year overall survival was 92.

Disease-free survival significantly improved in the overall population; the co-primary endpoint in the PD-L1 50 percent or greater population was not met.

Durvalumab with chemotherapy improved progression-free survival (5.

Physical function at five weeks 4.

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.

Untreated metastatic non-small-cell lung cancer with PD-L1 on at least 50 percent of tumour cells or 10 percent of tumour-infiltrating immune cells and no EGFR or ALK alteration

ALK-positive advanced non-small-cell lung cancer not previously treated with an ALK inhibitor

Untreated metastatic non-small-cell lung cancer, with nivolumab and two cycles of platinum doublet chemotherapy: not recommended

Locally advanced or metastatic PD-L1-positive non-squamous non-small-cell lung cancer after chemotherapy

Untreated metastatic non-small-cell lung cancer without an EGFR or ALK alteration, with ipilimumab and two cycles of platinum doublet chemotherapy: not recommended

Untreated metastatic non-squamous non-small-cell lung cancer without an EGFR or ALK alteration, with pemetrexed and platinum chemotherapy

ORR 71% (naive MTC), 89% (RET-fusion thyroid).

OS HR 0.

Amivantamab produced durable responses in EGFR exon 20 insertion non-small-cell lung cancer after platinum chemotherapy; accelerated approval in May 2021.

Median overall survival not reached vs 14.

Postoperative mediastinal radiotherapy did not improve three-year disease-free survival in completely resected N2 disease; mediastinal relapse fell but cardiopulmonary toxicity rose.

IMpower010: adjuvant atezolizumab after platinum chemotherapy improved disease-free survival in resected stage II to IIIA non-small-cell lung cancer, most in tumours with PD-L1 on 1 percent or more of tumour cells (hazard ratio 0.

42 cancers in 1,994 people scanned, 85.

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.

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.

Untreated extensive-stage small-cell lung cancer, with carboplatin and etoposide

ROS1-positive advanced non-small-cell lung cancer in patients who have not had a ROS1 inhibitor

ALK-positive advanced non-small-cell lung cancer progressing after alectinib or ceritinib as the first ALK inhibitor, or after crizotinib and at least one other ALK inhibitor

Locally advanced or metastatic squamous non-small-cell lung cancer after chemotherapy

Untreated locally advanced or metastatic EGFR mutation-positive non-small-cell lung cancer

EGFR T790M mutation-positive locally advanced or metastatic non-small-cell lung cancer after a first-line EGFR inhibitor

OS HR 0.

Median overall survival 14.

5-year PFS 60% vs 8%, HR 0.

Response rate 68% (treatment-naive, n=28) and 41% (previously treated, n=69) in MET exon 14 skipping disease; about a third in high-level MET amplification.

In the PD-L1-highest subgroup, median overall survival 20.

Genotype-matched targeted arms (taselisib, palbociclib, AZD4547) closed for futility; nivolumab plus ipilimumab did not beat nivolumab (S1400I); ramucirumab plus pembrolizumab improved overall survival against standard care (S1800A).

Objective response 35.

Independent-review objective response 46% (95% CI 36 to 57) among 99 patients with at least nine months of follow-up; median duration of response 11.

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.

Metastatic non-squamous non-small-cell lung cancer, with bevacizumab, carboplatin and paclitaxel

ALK-positive advanced non-small-cell lung cancer after crizotinib

Untreated locally advanced or metastatic EGFR mutation-positive non-small-cell lung cancer

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.

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).

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.

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.

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.

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.

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.

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.

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.

Investigator-assessed progression-free survival significantly longer with alectinib than crizotinib, consistent with the global ALEX trial.

OS 13.

Nivolumab plus ipilimumab improved overall survival over chemotherapy in PD-L1-positive advanced non-small-cell lung cancer; approved in the United States in May 2020.

Local failure hazard ratio 0.

Median overall survival 20.

No clear stage shift (54.

5-year OS 42.

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.

Untreated ALK-positive advanced non-small-cell lung cancer

Locally advanced or metastatic non-small-cell lung cancer after chemotherapy

Untreated ALK-positive advanced non-small-cell lung cancer

Untreated PD-L1-positive metastatic non-small-cell lung cancer with a tumour proportion score of 50 percent or more and no EGFR or ALK alteration

Median progression-free survival 24.

Median progression-free survival 18.

OS 12.

Median progression-free survival 8.

Pembrolizumab plus carboplatin and a taxane improved overall and progression-free survival over chemotherapy alone across PD-L1 levels; approved in October 2018.

ORR 75% by independent review in the first 55 pooled patients across 17 tumour types.

Locally advanced or metastatic PD-L1-positive non-small-cell lung cancer after at least one chemotherapy

Median progression-free survival 34.

Median total hospital days 10.

Median progression-free survival 14.

Median progression-free survival 10.

Confirmed objective response 64 percent (23 of 36), with 6 percent complete responses; grade 3 or worse adverse events in 69 percent.

Median progression-free survival 4.

No significant difference; twice-daily 45 Gy remains standard.

Stopped at the second interim analysis for a large progression-free survival advantage of alectinib over crizotinib.

OS HR 0.

Median overall survival 11.

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.

Locally advanced or metastatic non-small-cell lung cancer progressing after platinum-based chemotherapy, with docetaxel: not recommended

Median overall survival 10.

5-year OS 31.

Median overall survival 13.

Quality-adjusted life-years 46.

Squamous NSCLC after platinum: first PD-1 in lung cancer

Locally advanced, metastatic or locally recurrent non-small-cell lung cancer of adenocarcinoma histology progressing after first-line chemotherapy, with docetaxel

Median overall survival 9.

Median overall survival 12.

One-year overall survival 33 against 28 percent (hazard ratio 0.

Median overall survival 28.

Overall survival significantly longer with necitumumab added to gemcitabine and cisplatin, by roughly six weeks at the median; hypomagnesaemia, rash and thromboembolism were the added toxicities.

Pooled three-year overall survival 95 percent with stereotactic radiotherapy against 79 percent with surgery (hazard ratio 0.

A milestone in how this cancer is treated.

Median progression-free survival 3.

Objective response 72 percent (36 of 50); median duration of response 17.

Median progression-free survival 10.

Median overall survival 10.

Median progression-free survival 11.

No significant difference in breathlessness over 42 days (24.

Lung cancer mortality reduced 20% (NLST) and 24% in men (NELSON).

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.

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.

Relapsed small-cell lung cancer, oral topotecan, only where re-treatment with the first-line regimen is inappropriate and cyclophosphamide, doxorubicin and vincristine is contraindicated

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.

Hazard ratio for death 0.

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.

Symptomatic brain metastases at 1 year 14.

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.

Median survival 65.

Median survival 7.

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.

Adjuvant vinorelbine and cisplatin prolonged disease-free and overall survival in completely resected stage IB to II disease; grade 3-4 neutropenia in 88 percent.

In advanced disease, chemotherapy gave a hazard ratio for death of 0.

Pain response to initial treatment 71 percent after a single 8 Gy fraction against 73 percent after 24 Gy in multiple fractions (p=0.

Five-year survival 44.

A milestone in how this cancer is treated.

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.

Median survival 23 against 19 months (p=0.

Relative risk of death 0.

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.

24 percent reduction in the relative risk of death and an absolute two-year survival gain of nine percentage points, from 20 to 29 percent (p = 0.

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.

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.

Refractory testicular tumours; small-cell lung cancer (1986)

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.

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.