The first 60 days: Non-small-cell lung cancer

Staging tests establish exactly what and where the cancer is. Everything else follows from the answers.

Written by hand for this cancer from NHS, Macmillan, Cancer Research UK and charity pages, each item naming the page it came from. The days and weeks are the typical order those pages describe, not a schedule; tick what applies to you.

1. Day 1 to 7
   • Write down the name and number of your lung cancer clinical nurse specialist, and the hospital's 24-hour line, and keep both by the phone.NICE NG122 (1.1.1) says a lung cancer clinical nurse specialist should be available at all stages of care to support people and, as appropriate, their family members or carers, and (1.19.3) that people should know how to contact them between hospital visits. NICE NG122: lung cancer, support from clinical nurse specialists; NHS: tests and next steps for lung cancer
   • Ask which type of lung cancer it is (non-small-cell or small-cell), what stage, and whether the aim of treatment is cure or control.The NHS says treatment depends on the size of the cancer and where it is, the type, whether it has spread, whether the cancer has certain genetic changes and your general health, and that where the cancer cannot be cured the aim is to slow it down, help with symptoms and help you live longer. NHS: treatment for lung cancer
   • Ask whether enough tissue was taken for the molecular tests, and which gene panel was sent.NICE NG122 (1.2.11) says samples should be adequate, without unacceptable risk to the person, to permit pathological diagnosis including tumour subtyping and assessment of molecular markers, and (1.2.12) points to the National Genomics Test Directory for the sequencing panels that guide treatment. NICE NG122: lung cancer, diagnosis and staging
   • If you smoke or recently stopped, ask to be referred to a stop smoking service, and ask whether it changes the timing of any operation.NICE NG122 (1.3.1 and 1.3.2) says to inform people that smoking increases the risk of lung complications after surgery and to advise stopping as soon as the diagnosis is suspected, and (1.3.3) not to postpone surgery to allow people to stop, so the offer is a treatment with a reason rather than a condition; NHS Better Health lists local stop smoking services, nicotine replacement and stop smoking medicines, offers a free Personal Quit Plan and says reaching 28 days smoke free makes you 5 times more likely to quit for good. NICE NG122: lung cancer, management; NHS Better Health: quit smoking
2. Week 1 to 2
   • Staging tests: a contrast CT of the chest, liver, adrenals and lower neck, usually a bronchoscopy or needle biopsy, and a PET-CT if treatment aimed at cure is possible.NICE NG122 (1.2.2) says to offer a contrast-enhanced chest CT including the liver, adrenals and lower neck, (1.2.4) that all people who could potentially have treatment with curative intent are offered PET-CT before treatment, and (1.2.8) to offer endobronchial ultrasound-guided needle aspiration for the nodes near the airways. NICE NG122: lung cancer, diagnosis and staging; NHS: tests and next steps for lung cancer
   • If an operation or radical radiotherapy is being considered, ask for your breathing test results and what they mean.NICE NG122 (1.4.9) says to perform spirometry and transfer factor testing before treatment with curative intent, (1.4.11) to perform a functional segment count to predict lung function after surgery, and (1.4.1) to use a global risk score such as Thoracoscore and make sure you are aware of the risk before you consent. NICE NG122: lung cancer, management
   • Learn the three things that help breathlessness today: a handheld fan pointed at your face, relaxed tummy breathing, and a supported forward lean.Cancer Research UK describes relaxed tummy breathing practised for 10 minutes twice a day when you are not breathless, recovery breathing with a fan and a forward lean for when you are, and pursed lips breathing; NICE NG122 (1.15.3 and 1.15.4) says to consider breathing control and coping strategies delivered by someone with expertise in the techniques, available in all care settings. Cancer Research UK: coping with breathlessness when you have lung cancer; NICE NG122: lung cancer, palliative interventions and supportive and palliative care
   • Tell the team about any breathlessness, cough, pain, weight loss or appetite change now, rather than saving it for the next clinic.Macmillan says to contact your doctor straight away if breathlessness is a new symptom, if you have pain when you breathe, or if it gets worse quickly; NICE NG122 (1.18.1) says weight loss, loss of appetite, depression and difficulty swallowing should be managed by multidisciplinary groups including supportive and palliative care professionals. Macmillan: breathlessness; NICE NG122: lung cancer, palliative interventions and supportive and palliative care
3. Week 2 to 4
   • Ask when your case goes to the lung multidisciplinary team, and whether you will be seen by both a thoracic surgeon and an oncologist.NICE NG122 (1.6.1) says all people whose condition is potentially suitable for multimodality treatment should be assessed by a thoracic oncologist and by a thoracic surgeon, so seeing both is the standard rather than a second opinion. NICE NG122: lung cancer, management
   • Ask when the molecular and PD-L1 results are due, and whether treatment should wait for them.NICE NG122 (1.2.12) points teams at the National Genomics Test Directory panels, and its advanced disease treatment pathways are organised by PD-L1 below or at or above 50 percent, so these two results decide between tablets, immunotherapy and chemotherapy. NICE NG122: lung cancer, diagnosis and staging; NICE NG122: lung cancer, management
   • Ask whether a clinical trial is open to you, here or elsewhere, and what taking part would involve.The NHS says you can ask your doctor or a patient organisation about clinical trials you may be eligible to join, that you would usually be randomly assigned to the new treatment or to a control group, and that you can leave at any point without giving a reason and without it affecting your care. NHS: clinical trials
   • Sort the practical things early: work, sick pay, benefits, travel costs and a Blue Badge.Cancer Research UK lists money matters, benefits, sick pay, prescription costs, grants, work issues, childcare, Blue Badge applications, help with travel costs and home adaptations, says a hospital social worker can help, and says getting help early stops these becoming a bigger issue later; Roy Castle has sections on employment rights and financial support. Cancer Research UK: coping and support when you have lung cancer; Roy Castle Lung Cancer Foundation: living with lung cancer
4. Week 3 to 6
   • Put the red cards on the fridge: struggling to breathe, coughing up more than a few streaks of blood, a temperature above 37.5 C or below 36 C, swelling of the face or neck, new leg weakness with back pain.The NHS says to call 999 if you are struggling to breathe or coughing up more than a few spots or streaks of blood; Macmillan says to ring the 24-hour number for a temperature above 37.5 C or below 36 C or feeling unwell with a normal temperature, and for breathlessness, a new cough or wheezing on immunotherapy. NHS: symptoms of lung cancer; Macmillan: pembrolizumab (Keytruda)
   • If you are on immunotherapy, carry the patient alert card and know that reactions can start after treatment ends.Macmillan says your team gives you a patient alert card and 24-hour contact numbers, that you can call at any time of day or night, and that immune side effects can start during treatment or after treatment ends. Macmillan: pembrolizumab (Keytruda)
   • Ask to be referred to palliative care alongside your cancer treatment if the cancer has spread.A randomised trial in newly diagnosed metastatic non-small-cell lung cancer found that early palliative care alongside standard oncology care improved quality of life, halved depressive symptoms (16 against 38 percent) and lengthened median survival (11.6 against 8.9 months); Marie Curie says palliative care can be given alongside treatments aimed at controlling the illness. Temel et al., early palliative care for patients with metastatic non-small-cell lung cancer (NEJM 2010); Marie Curie: what is palliative care?
5. By day 60
   • Know your follow-up: an appointment with a specialist within 6 weeks of finishing treatment, then regular appointments arranged for you.NICE NG122 (1.19.1) says to offer everyone with lung cancer an initial follow-up appointment with a specialist within 6 weeks of completing treatment and regular appointments after that, rather than relying on the person requesting appointments when they have symptoms, and (1.19.2) that nurse-led protocol-driven follow-up is an option. NICE NG122: lung cancer, follow-up and patient perspectives
   • Find your people: Roy Castle's nurse-staffed line and groups, Cancer Research UK's nurse line and forum, and your nearest Maggie's centre.Roy Castle Lung Cancer Foundation offers support online, in person and by phone, including a telephone line staffed by lung cancer nurses, information days and support groups; Cancer Research UK says specialist nurses are usually the first point of call if you are finding it difficult to cope. Roy Castle Lung Cancer Foundation: the support available to you; Cancer Research UK: coping and support when you have lung cancer
   • If the stigma around lung cancer is making it harder to ask for help, say so to your nurse specialist. Nothing about your care depends on whether you smoked.Cancer Research UK lists guilt among the common feelings after a lung cancer diagnosis and says specialist nurses can get you the help you need; NICE NG122 (1.3.3) says not to postpone surgery to allow people to stop smoking, which is the guideline saying plainly that treatment is not conditional. Cancer Research UK: coping and support when you have lung cancer; NICE NG122: lung cancer, management

These specialties appear in the standard of care for this cancer. In most centres they meet weekly as a tumour board to agree each plan; you can ask when yours was discussed and what was decided.

• PathologistNamed in the standard of care for: Screening (age 50-80, ≥20 pack-years), Metastatic, EGFR exon 19 del / L858R.
• RadiologistNamed in the standard of care for: Screening (age 50-80, ≥20 pack-years).
• SurgeonNamed in the standard of care for: Screening (age 50-80, ≥20 pack-years), Stage I-II resectable.
• Medical oncologistNamed in the standard of care for: Stage I-II resectable, Stage III unresectable, Metastatic, EGFR exon 19 del / L858R, Metastatic, EGFR exon 20 insertion and 11 more.
• Clinical oncologist (radiotherapy)Named in the standard of care for: Stage I-II resectable, Stage III unresectable.

A second opinion from a centre that treats many similar cases is normal, not rude; the standard of care tells you what to compare it against.

Each row is a setting from the standard of care, in the order it usually arises. Not all will apply to you; your stage and biomarkers decide which do. The guideline grade, where recorded, says how strong the evidence is.

1. 1.Screening (age 50-80, ≥20 pack-years)

   Annual low-dose CT with Lung-RADS reporting; AI nodule scoring emerging; robotic bronchoscopy for peripheral nodule biopsy.

   Low-dose CT lung screeningNLST & NELSON (low-dose CT screening)Robotic and navigational bronchoscopyAI in radiology
2. 2.Stage I-II resectable

   Lobectomy or segmentectomy (small peripheral) with nodal staging; SBRT if inoperable. Stage IB-IIIA: neoadjuvant chemo-IO (CheckMate 816) or perioperative chemo-IO (KEYNOTE-671); adjuvant osimertinib if EGFR-mutant (ADAURA), alectinib if ALK-positive (ALINA); adjuvant chemotherapy otherwise for stage II+.

   Robotic & minimally invasive surgerySBRT / SABR (stereotactic radiotherapy)CheckMate 816KEYNOTE-671ADAURAALINAOsimertinibAlectinib
3. 3.Stage III unresectable

   Concurrent platinum chemoradiation → durvalumab 1 year (PACIFIC), or osimertinib until progression if EGFR-mutant (LAURA). Proton therapy in selected cases.

   IMRT / IGRT (modern external beam)PACIFICLAURADurvalumabOsimertinibProton therapy
4. 4.Metastatic, EGFR exon 19 del / L858R

   First line: osimertinib ± platinum-pemetrexed (FLAURA2) or amivantamab + lazertinib (MARIPOSA, OS benefit). Progression: re-biopsy/ctDNA; amivantamab + chemotherapy (MARIPOSA-2), Dato-DXd (TROPION-Lung05), platinum doublet; MET TKI add-on if MET-amplified; platinum-etoposide if small-cell transformation.

   OsimertinibFLAURA2AmivantamabLazertinibMARIPOSAAmivantamab + lazertinib (first-line EGFR NSCLC)Datopotamab deruxtecanTROPION-Lung05EGFR exon 19 deletion & L858REGFR C797SMET amplification (bypass resistance)Histologic transformation
5. 5.Metastatic, EGFR exon 20 insertion

   Amivantamab + platinum-pemetrexed (PAPILLON); sunvozertinib later line.

   AmivantamabEGFR exon 20 insertion
6. 6.Metastatic, ALK-rearranged

   Lorlatinib (CROWN; 5-year PFS 60%) or alectinib first line; on progression, neladalkib (under review) or lorlatinib if not used; local therapy for oligoprogression; chemotherapy.

   LorlatinibCROWNAlectinibNeladalkibALKOVE-1Oligoprogression
7. 7.Metastatic, ROS1-rearranged

   Repotrectinib or zidesamtinib (2026) first line; entrectinib/crizotinib alternatives.

   RepotrectinibZidesamtinibROS1
8. 8.Metastatic, KRAS G12C

   First line: PD-(L)1 ± chemotherapy by PD-L1 (G12C inhibitor + IO combinations in phase 3: olomorasib SUNRAY-01, divarasib Krascendo 2). Second line: sotorasib or adagrasib (CodeBreaK 200, KRYSTAL-12); divarasib superior head-to-head (Krascendo 1, 2026).

   SotorasibAdagrasibDivarasibOlomorasibCodeBreaK 200KRYSTAL-12Krascendo 1KRAS & RAS inhibitors
9. 9.Metastatic, BRAF V600E

   Dabrafenib + trametinib or encorafenib + binimetinib first line; chemo-IO as alternative.

   Dabrafenib + trametinibEncorafenibBRAF
10. 10.Metastatic, MET exon 14 skipping

    Capmatinib or tepotinib first line; telisotuzumab vedotin for c-Met-overexpressing EGFR-wild-type disease after chemotherapy (accelerated 2025).

    Capmatinib & tepotinibTelisotuzumab vedotinTeliMET NSCLC-01MET
11. 11.Metastatic, RET-fusion

    Selpercatinib first line (LIBRETTO-431); pralsetinib alternative.

    SelpercatinibLIBRETTO-431PralsetinibRET
12. 12.Metastatic, HER2-mutant

    First line: zongertinib (2026) or chemo-IO; sevabertinib (Nov 2025) or T-DXd after prior therapy.

    ZongertinibSevabertinibSOHO-01Trastuzumab deruxtecanHER2
13. 13.Metastatic, NTRK-fusion

    Larotrectinib, entrectinib, or repotrectinib (tumour-agnostic).

    RepotrectinibNTRKTumour-agnostic (tissue-agnostic) approval
14. 14.Metastatic, driver-negative, PD-L1 TPS ≥50%

    Pembrolizumab (KEYNOTE-024) or cemiplimab monotherapy; add chemotherapy for high burden or rapid progression. Ivonescimab beat pembrolizumab in China (HARMONi-2); not approved in the US.

    PembrolizumabCemiplimabKEYNOTE-024 & KEYNOTE-189IvonescimabHARMONi-2Tumour proportion score (TPS)
15. 15.Metastatic, driver-negative, PD-L1 TPS <50%

    Pembrolizumab + platinum doublet (KEYNOTE-189 non-squamous; KEYNOTE-407 squamous); nivolumab + ipilimumab ± chemotherapy; tremelimumab + durvalumab + chemotherapy for PD-L1-negative or STK11/KEAP1-altered disease. Second line: docetaxel ± ramucirumab, TTFields, or trials of ADCs.

    PembrolizumabNivolumabIpilimumabTremelimumabDurvalumabPD-1 blockade + chemotherapy in PD-L1-low NSCLCOptune / Optune Pax (TTFields)
16. 16.Metastatic, squamous

    Pembrolizumab + carboplatin + (nab-)paclitaxel (KEYNOTE-407); no ADC approved (TROPION-Lung01 showed no benefit in squamous); ivonescimab + chemotherapy under study (HARMONi-3).

    PembrolizumabPaclitaxel / nab-paclitaxelCarboplatinTROPION-Lung01HARMONi-3

Generated from this cancer's standard of care, biomarkers and open problems. Take the group that matches where you are. To tick, add your own and print, open the one-page appointment sheet.

Trials open now for this cancer in OnCo, largest phase first. Joining a trial is a decision like any other: ask what the comparison arm is, whether a placebo is used, and what happens if you leave. The cancer page searches ClinicalTrials.gov live for more.

• A Clinical Study of Calderasib (MK-1084) and Other Treatments for Participants With Non-Small Cell Lung Cancer (MK-1084-007/KANDLELIT-007)Phase 3 · recruiting · NCT07190248A Phase 3, Randomized, Open-label, Multicenter Clinical Study to Evaluate the Safety and Efficacy of MK-1084 in Combination With Subcutaneous Pembrolizumab and Berahyaluronidase Alfa (MK-3475A) Versus MK-3475A in Combination With Pemetrexed/Platinum (Carboplatin or Cisplatin) Chemotherapy as First-line Treatment of Participants With KRAS G12C-Mutant, Advanced or Metastatic Nonsquamous NSCLC (KANDLELIT-007)
• A Clinical Study of JMT101 in Combination With Osimertinib Versus Osimertinib Alone as First-Line Treatment for Patients With Locally Advanced or Metastatic Non-Squamous Non-Small Cell Lung Cancer (NSCLC) Harboring Epidermal Growth Factor Receptor (EGFR) Sensitive MutationsPhase 3 · recruiting · NCT06735391A Phase 3 Clinical Study of JMT101 in Combination With Osimertinib Versus Osimertinib Alone as First-Line Treatment for Patients With Locally Advanced or Metastatic Non-Squamous Non-Small Cell Lung Cancer (NSCLC) Harboring Epidermal Growth Factor Receptor (EGFR) Sensitive Mutations
• A Clinical Study of Pembrolizumab (+) Berahyaluronidase Alfa (MK-3475A) to Treat Newly-diagnosed Metastatic Non-small Cell Lung Cancer (MK-3475A-F84)Phase 3 · active · NCT06698042A Phase 3 Randomized, Open-label Clinical Study to Evaluate the Pharmacokinetics and Safety of Subcutaneous Pembrolizumab Coformulated With Hyaluronidase (MK-3475A) Versus Intravenous Pembrolizumab, in the First-line Treatment of Participants With Metastatic Non-small Cell Lung Cancer With PD-L1 TPS 50% or Greater
• A Clinical Trial of Adjuvant Intismeran (V940) With or Without Pembrolizumab Coformulated With Berahyaluronidase Alfa (MK-3475A) in High-Risk Stage I Phase 3 · recruiting · NCT07513376A Phase 3, Randomized, Placebo-Controlled Study of Adjuvant Intismeran Autogene Plus Subcutaneous Pembrolizumab and Berahyaluronidase Alfa (MK-3475A) or Intismeran Autogene Monotherapy Versus Placebo in Participants With Completely Resected High-Risk Stage I Non-Small Cell Lung Cancer (INTerpath-014)
• A Clinical Trial of Calderasib (MK-1084) and Durvalumab in People With Non-Small Cell Lung Cancer (MK-1084-015/KANDLELIT-015)Phase 3 · recruiting · NCT07554339A Phase 3, Randomized, Double-blind, Placebo- and Active-Comparator-Controlled Study of MK-1084 Plus Durvalumab Versus Placebo Plus Durvalumab in Participants With Locally Advanced, Unresected KRAS G12C-Mutant Non-Small Cell Lung Cancer Without Disease Progression Following Definitive Platinum-Based Chemoradiotherapy (KANDLELIT-015)

Much of what helps in the first weeks is free if you know to ask: testing, helplines, rides and lodging, second opinions, trial travel.

• Free in oncologyFree testing, helplines, rides and lodging, second opinions and trial travel help, with who is eligible.
• Financial helpManufacturer programmes, national schemes and charities by country and product.
• Second opinionExpert centres for this cancer in your country and how referral works.

• Non-small-cell lung cancer: the full pageNon-small-cell lung cancer is the proving ground for precision medicine: a dozen targetable mutations each with a matched pill, immunotherapy for the rest, and ADCs and bispecifics arriving now. Because most cases are still found late, low-dose CT screening is the other half of the story.
• One-page appointment sheetYour questions, the words you may hear, what to bring, and space for the answers. Print it.
• Treatment journey: Stage II-IIIA (resectable)Molecular testing splits the road: without a driver mutation, chemo-immunotherapy comes before surgery and immunotherapy after; with an EGFR or ALK alteration, surgery is followed by a targeted tablet for two to three years.
• Guidelines comparedNCCN, ESMO and NICE side by side for this cancer.
• Treatment sequencingWhich treatment tends to follow which, line by line.
• NavigatorStandard of care for your stage, what you have tried, and trials near you.