85% of all lung cancer cases are categorised as non-small cell lung cancer (NSCLC). In the past decade, considerable advancements in the diagnosis and treatment of NSCLC have improved patient survival and contributed to an overall decline in lung cancer mortality. These advances stem from a better understanding of factors driving the development of NSCLC other than smoking, especially through the identification of important genetic drivers. Despite these advances, lung cancer remains the leading cause of cancer deaths globally, attributable to 1.8 million deaths in 2022, which is double the mortality rate of colorectal cancer, the second most fatal cancer.
While promoting smoking cessation is pivotal in mitigating NSCLC incidence, it is imperative to confront the barriers hindering early NSCLC screening and the integration of innovative therapies into real-world application, to further augment the survival rates of NSCLC patients.
Patient survival in NSCLC largely relies on early-stage diagnosis, yet almost half of cases are diagnosed with distant metastases. Despite the proven efficacy of low-dose CT screening in reducing mortality by 20% through early identification, challenges such as low uptake and the absence of organised screening programmes hinder its potential to improve survival rates. In a positive development, the European Commission has made progress in 2022 by expanding cancer screening recommendations to include lung cancer. The SOLACE project, part of the European Beat Cancer Plan, aims to establish lung cancer screening programmes in ten countries. However, data that are crucial for cost-effective implementation of screening programmes will not be available until 2026, emphasising the urgent need to focus on the timely integration of novel therapies into clinical practice to enhance survival rates.
In The Lancet Regional Health – Europe’s Series on advancements in NSCLC, leading experts in the field convened to identify breakthroughs in targeted therapies and biomarker identification for both early and advanced-stage NSCLC, with the potential to significantly enhance survival rates when widely implemented in clinical practice. The experts evaluated emerging challenges in utilisation and implementation, while providing recommendations for prioritising actions to bridge the gap between clinical progress and real-world application.
For advanced-stage NSCLC, comprehensive molecular testing to identify genetic drivers is crucial for targeted therapy selection. However, availability of testing varies across Europe due to financial barriers, which makes treatment decisions more complex for clinicians. The evolving nature of genetic driver identification poses another challenge, necessitating continuous development of new biomarkers and therapies. This impedes optimal test selection, result interpretation, treatment decisions, and patient survival as clinicians struggle to keep up to date. Additionally, molecular testing techniques are costly and often inaccessible, with less than 10% of required tests performed in Europe.
Experts advocate centralising large-scale molecular testing within an oncology network that includes a multidisciplinary tumour board, comprising health professionals with different expertise, to address these challenges. In addition to the cost-benefit, involving a multidisciplinary tumour board not only allows for personalised and standardised treatment recommendations but also simplifies the decision making process for clinicians. Successful initiatives such as the National Network Genomic Medicine for Lung Cancer in Germany, a centralised nationwide program offering comprehensive molecular diagnostics and personalised therapy for patients with advanced NSCLC, demonstrate the effectiveness of such multidisciplinary programs in prolonging overall survival.
For early-stage NSCLC, the introduction of immunotherapies and targeted therapies has shown promising improvements in tumour responses and survival outcomes. Although further mature survival data is needed, these developments represent a substantial improvement in patient survival prospects, with some neoadjuvant and adjuvant regimens receiving regulatory approvals. However, these advancements have also led to questions and uncertainties, complicating decisions for clinicians regarding patient selection, therapy duration, and treatment timing. The absence of a uniform definition of resectability further adds to challenge of identifying appropriate patients for neoadjuvant therapy. Moreover, delays in regulatory approvals for novel therapies and variations in post-approval assessment of cost-effectiveness and reimbursement criteria across European countries further complicate matters.
To advance personalised treatment and improve survival, experts advocate for the establishment of consensual resectability criteria to better interpret study results and develop sub-stage-specific treatment guidelines. Experts also call on stakeholders involved in the marketing authorisation phase to improve regulatory timelines, as well as to start price negotiations immediately after approval and streamline national reimbursement processes to accelerate patient access to these novel therapies.
Harnessing the full potential of clinical advancements in NSCLC diagnosis and treatment is crucial to reducing lung cancer mortality. Urgent action is necessary to prevent the projected doubling of cancer deaths by 2050, as warned by the WHO, with lung cancer anticipated to claim the majority of these lives. A collaborative effort among researchers, pharmaceutical companies, healthcare providers, and policymakers is imperative. Together, they must strive for standardized assessment of NSCLC diagnosis and streamline the approval process for these innovative treatments across Europe. This concerted endeavor is essential to ensure that every patient receives timely and effective interventions.