Lung Cancer: Non-Small Cell Management

Key points

• Non-small cell lung cancer (NSCLC): management is guided by stage and molecular profile.
• Surgery (lobectomy) is the treatment of choice for early-stage (I-II) disease but only about 20% are suitable; assess lung function and mediastinal nodes (EBUS/mediastinoscopy, as CT may miss nodal involvement).
• Radical radiotherapy (including stereotactic ablative radiotherapy, SABR) for early-stage disease unfit for surgery; chemoradiotherapy for locally advanced (stage III).
• Advanced/metastatic disease is driven by molecular testing: EGFR mutation → an EGFR TKI (e.g. osimertinib); ALK/ROS1 rearrangement → an ALK inhibitor; otherwise immunotherapy (PD-1/PD-L1 inhibitors such as pembrolizumab) with or without chemotherapy, guided by PD-L1 expression.
• Palliative care and symptom control throughout. Surgery is contraindicated by poor lung function, significant comorbidity, or extensive/metastatic disease.