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Lung cancer caught before it has spread is treated with surgery, now often keyhole or robotic and sometimes removing only part of a lobe. Immunotherapy given before and after the operation, or a targeted pill afterwards for EGFR or ALK tumours, cuts the chance of the cancer coming back by between a third and four fifths.
Surgery has cured lung cancer since Evarts Graham's pneumonectomy in 1933, and lobectomy with mediastinal node dissection became the standard after the 1995 Lung Cancer Study Group trial found more recurrences with lesser resections. Staging rests on PET-CT and, for central or node-suspicious tumours, endobronchial ultrasound sampling of the mediastinum; brain MRI is added from stage II. Two trials in 2022 and 2023, JCOG0802 and CALGB 140503, showed that segmentectomy or wedge resection is as good as lobectomy for peripheral tumours of 2 cm or less, the tumours that screening finds, and most resections are now by video-assisted or robotic thoracoscopy. Stereotactic radiotherapy cures most stage I tumours in patients who cannot have surgery (CHISEL, JCOG0403). Adjuvant cisplatin doublet chemotherapy, established by the LACE meta-analysis in 2008, adds about 5 percent to five-year survival in stage II and III.
The decade since 2020 has added systemic therapy on both sides of the operation. ADAURA (2020) showed that three years of adjuvant osimertinib in EGFR-mutated stage IB to IIIA cut recurrence by 83 percent and improved five-year survival from 78 to 88 percent, and ALINA (2024) did the same for two years of alectinib in ALK-positive disease (hazard ratio 0.24). For the majority without a driver, IMpower010 (2021) showed adjuvant atezolizumab improved disease-free survival in PD-L1-positive stage II to IIIA (hazard ratio 0.66), CheckMate 816 (2022) showed that three cycles of nivolumab with chemotherapy before surgery raised pathological complete response from 2 to 24 percent and improved event-free and, later, overall survival, and the perioperative trials that give immunotherapy before and after surgery, KEYNOTE-671 (pembrolizumab, event-free survival hazard ratio 0.58, overall survival hazard ratio 0.72), AEGEAN (durvalumab, hazard ratio 0.68) and CheckMate 77T (nivolumab, hazard ratio 0.58), all followed, with approvals between 2022 and 2024.
The open questions are practical: whether the adjuvant phase adds anything for patients who already had a complete pathological response, whether circulating tumour DNA after surgery can pick out who needs more treatment and who needs none, how to avoid immunotherapy toxicity that prevents an operation, and how to stage patients accurately enough to give the right group neoadjuvant treatment. Driver testing before any neoadjuvant immunotherapy is now essential because EGFR- and ALK-positive tumours gain little and should go to targeted adjuvant therapy instead.
Averages across everyone diagnosed, often years ago. A median is the middle of a group: half the people counted lived longer than the figure shown, and some lived far longer. Your stage, subtype, age, fitness and the treatment you receive matter more than the average, and the numbers are improving quickly.
Central tumours arise in the large airways, peripheral ones in the alveoli; both drain to hilar then mediastinal nodes, and the pleural lining is a separate cancer site.
Same organ: Mediastinal germ cell tumour, Pleuropulmonary blastoma (types I, Ir, II and III), Type A and type AB thymoma, Type B1 and type B2 thymoma, Type B3 thymoma, Micronodular thymoma with lymphoid stroma, Adenocarcinoma of the lung, Squamous cell carcinoma of the lung, Large cell carcinoma of the lung, Sarcomatoid carcinoma of the lung, Adenosquamous carcinoma of the lung, Invasive mucinous adenocarcinoma of the lung, Adenocarcinoma in situ and minimally invasive adenocarcinoma of the lung, Basaloid squamous cell carcinoma of the lung, Lymphoepithelial carcinoma of the lung, Pulmonary blastoma (adult), Non-small-cell lung cancer, Lung cancer (all types), Small-cell lung cancer, Mesothelioma, Pleural mesothelioma, Thymoma and thymic carcinoma, Childhood lung and airway tumours (pleuropulmonary blastoma, tracheobronchial tumours), Inflammatory myofibroblastic tumour (IMT), EGFR-mutated non-small-cell lung cancer, ALK-positive non-small-cell lung cancer, KRAS G12C-mutant non-small-cell lung cancer, ROS1-positive non-small-cell lung cancer, MET exon 14 and MET-amplified non-small-cell lung cancer, RET fusion-positive non-small-cell lung cancer, BRAF V600E-mutant non-small-cell lung cancer, HER2-mutant non-small-cell lung cancer, NTRK fusion-positive non-small-cell lung cancer, PD-L1-high non-small-cell lung cancer without a driver mutation, Unresectable stage III non-small-cell lung cancer, Limited-stage small-cell lung cancer, Extensive-stage small-cell lung cancer, Lung neuroendocrine tumours (typical and atypical carcinoid), Large cell neuroendocrine carcinoma of the lung, Thymoma (WHO types A, AB, B1, B2 and B3), Thymic carcinoma
Nothing recorded yet.
Also on OnCo: Symptoms and red flags · Early detection roadmap.
Segmentectomy or lobectomy by video-assisted or robotic thoracoscopy with node dissection (CALGB 140503, JCOG0802); no systemic therapy; stereotactic radiotherapy if not fit for surgery.
Neoadjuvant nivolumab plus platinum chemotherapy for three cycles (CheckMate 816) or perioperative pembrolizumab (KEYNOTE-671), durvalumab (AEGEAN) or nivolumab (CheckMate 77T) with chemotherapy before and immunotherapy for a year after surgery; or surgery first then adjuvant cisplatin doublet and atezolizumab or pembrolizumab if PD-L1-positive (IMpower010).
Adjuvant platinum chemotherapy where indicated, then three years of osimertinib (ADAURA).
Two years of adjuvant alectinib in place of chemotherapy (ALINA).
PET-CT and mediastinal sampling before surgery; CT every six months for two years then yearly; circulating tumour DNA surveillance in trials.
Trials recruiting now, the landmark trials, the trials held by this cancer's subtypes, the key papers and what they mean, the latest literature, and the milestones year by year.
The targets of this cancer's medicines and the ones linked to it directly.
Cases by country, the UK and NHS pathway and other country lenses, the expert centres with trials on record, and the centres named on this cancer's subtypes.
One section per setting: the options named, what each is for, the trials behind them, the recorded trade-offs and the questions to ask.
Persistent headache with extreme tiredness, nausea, dizziness on standing or low blood pressure. Vomiting, severe weakness or collapse is adrenal crisis.
Bleeding that does not stop by itself, bleeding from more than one site, or new bruising in several places or one large area.
Fainting, near-fainting, or an irregular or racing heartbeat; several kinase inhibitors prolong the QT interval and the labels require ECG and electrolyte monitoring.
Take with food; exposure roughly triples with a high-fat meal, and the trials dosed with food.
No pharmacokinetic interactions expected (antibody). See the irAE guide for toxicity management.
Known QT prolongation. Avoid other QT-prolonging drugs where possible; check ECG and correct potassium and magnesium before and during treatment.
See all on the product pages:AlectinibAtezolizumabCarboplatinCisplatinDurvalumabNivolumabOsimertinibPembrolizumabPemetrexed·Printable cards in the navigator
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Everything in development, the medicines held by this cancer's subtypes, the open problems and what is being done about them, the roadmaps, and what changed on this record.
Every connected record, the notes, the JSON, Markdown and RDF twins, and where the record came from and when it was checked.