# Treatment methods for non-small cell lung cancer
The treatment of non-small cell lung cancer (NSCLC) is strongly dependent on the stage of the disease, the genetic characteristics of the tumor, and the patient's general health. Below we describe the main treatments by phase and treatment group.
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Surgery
In early stage (I–II) and some cases of stage III, surgical removal of the tumor is often the first choice. The surgeon removes the affected lung tissue, usually a lung lobe (lobectomy) or part of it (segmental resection), together with surrounding lymph nodes.
ProveniIncluded in official guidelines, or approved by EMA or FDA
Surgery is based on decades of experience and is listed in all international guidelines as standard treatment for resectable tumors. Recent studies show that robotic assistance in this procedure has been performed safely and produces the same results as open surgery, with possibly fewer complications. The risks depend on the extent of the procedure and the patient's lung function; complications can include infections, bleeding, or fluid accumulation around the lung.
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Chemotherapy
Chemotherapy is used in various situations: sometimes before surgery (neoadjuvant) to shrink the tumor, sometimes after (adjuvant) to fight remaining cells, or as primary treatment in advanced stages.
ProveniIncluded in official guidelines, or approved by EMA or FDA
Chemotherapy has been the standard treatment for more than two decades and is listed in all guidelines. It works by causing DNA damage to dividing cells. Commonly used combinations contain platinum-based substances (cisplatin or carboplatin) together with other agents. Common side effects are nausea, fatigue, hair loss, reduced white and red blood cell count (which causes increased infection risk and anemia), and neuropathy (tingling in fingers and toes).
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Targeted therapy
When a tumor contains specific genetic mutations (such as in the EGFR, ALK, ROS1, MET, KRAS G12C genes or others), medications targeting these mutations can be highly effective.
EGFR inhibitors
ProveniIncluded in official guidelines, or approved by EMA or FDA
These medications block the growth signal sent by EGFR mutations. They are used as first-line treatment in patients with EGFR-mutated tumors and often provide faster response than chemotherapy alone. Known side effects are skin rash (acne-like), diarrhea, fatigue, and in rare cases severe lung inflammation.
ALK, ROS1, and MET inhibitors
ProveniIncluded in official guidelines, or approved by EMA or FDA
These target other genetic abnormalities. They work similarly to EGFR inhibitors: they block aberrant growth signals. Side effects vary but often include stomach problems, fatigue, and vision changes.
KRAS G12C inhibitors
ResearchediPositive results in clinical studies, not yet standard treatment
Inhibitors targeting KRAS G12C mutations have been shown to be effective in clinical trials. Multiple studies suggest benefit, especially in combination with other agents. This treatment is currently being evaluated on a larger scale in ongoing trials.
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Immunotherapy (immune checkpoint inhibitors)
These medications 'unlock' the immune system so it can fight the cancer itself.
PD-1/PD-L1 inhibitors
ProveniIncluded in official guidelines, or approved by EMA or FDA
Medications such as pembrolizumab, nivolumab, and durvalumab have been used in all disease stages and are listed in official guidelines. They work by lifting the suppression of control proteins on immune cells, allowing these cells to better recognize and attack cancer. In stage III, after combination with chemoradiation, durvalumab has become standard as consolidation therapy.
Side effects of PD-1/PD-L1 inhibitors are immune-related: inflammation in lungs, intestines, liver, or hormone glands can occur. Some patients experience skin reactions, arthralgias (joint pain), or fatigue.
Combinations of immunotherapy and chemotherapy
ProveniIncluded in official guidelines, or approved by EMA or FDA
In advanced stages, immunotherapy is regularly combined with chemotherapy. Studies show that this combination is more effective than each drug alone. Side effects are additive: both chemo- and immunity-related toxicity can occur.
SGLT2 inhibitors in combination with immunotherapy
ResearchediPositive results in clinical studies, not yet standard treatment
Recent studies suggest that SGLT2 inhibitors (drugs originally developed for diabetes) can improve the effectiveness of immunotherapy. This is now being systematically investigated; to date, results point to potential benefits, especially for patients with comorbidities.
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Radiotherapy
Radiotherapy destroys tumor cells through ionizing radiation. It is used in various contexts.
Primary radiotherapy (non-resectable stages)
ProveniIncluded in official guidelines, or approved by EMA or FDA
In patients who cannot be operated on or who are not candidates for surgery, radiotherapy is standard. This is often combined with chemotherapy (chemoradiation). Side effects can include radiodermatitis (skin damage), fatigue, and, in the case of thoracic radiation, lung toxicity (inflammation or fibrosis).
Carbon-ion radiotherapy
ResearchediPositive results in clinical studies, not yet standard treatment
This is a more advanced form of radiotherapy in which heavy ions are used instead of photons (regular X-ray radiation). This theoretically offers greater precision and less damage to surrounding tissue. Studies are now comparing its biological effectiveness with conventional photon radiotherapy. This technology is not yet widely available.
Stereotactic radiotherapy (SBRT)
ProveniIncluded in official guidelines, or approved by EMA or FDA
For small tumors in early stage, highly concentrated radiation in a few sessions may be sufficient. This is a recognized option, especially for patients who cannot or do not wish to be operated on.
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Combination treatments in stage III
For locally advanced (stage III) non-resectable lung cancer, the current standard is:
1. **Chemoradiotherapy**: concurrent chemotherapy and radiotherapy
2. **Consolidation treatment**: followed by immunotherapy (durvalumab)
ProveniIncluded in official guidelines, or approved by EMA or FDA
This approach is supported by multiple large randomized trials and is included in international guidelines. Real-world data from 2024–2026 confirms that consolidation immunotherapy after chemoradiation improves survival, although not all patients receive this treatment due to social and health circumstances.
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Supportive measures
In addition to direct cancer treatment, supportive treatments are important.
Cardiotoxicity management
ResearchediPositive results in clinical studies, not yet standard treatment
Some cancer treatments (particularly certain tyrosine kinase inhibitors) can impair heart function. Research is now investigating how natural or pharmacological substances (such as salidroside) can alleviate this toxicity. This is in the research stage and is not yet standard practice.
Palliative and supportive care
ProveniIncluded in official guidelines, or approved by EMA or FDA
Pain management, nutritional support, psychosocial assistance, and other symptom management are an integral part of treatment at any point in the disease, not just at the end. This significantly improves quality of life.
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Emerging and experimental approaches
Biomarkers and circulating tumor DNA (ctDNA)
ResearchediPositive results in clinical studies, not yet standard treatment
Studies show that measuring tumor DNA in blood (ctDNA) can early predict how well a patient responds to immunotherapy. This is being investigated for prognostic and predictive insight, but is not yet a routine measure.
Methylation fragmentomics of cfDNA
ResearchediPositive results in clinical studies, not yet standard treatment
This is an advanced, non-invasive test that analyzes DNA fragments in blood for disease signatures after surgery. It can help identify patients at high risk of recurrence. This is in the research stage.
Photodynamic therapy
ExperimentaliOngoing in study setting, outcome still unknown
New photosensitizers are being investigated for their ability to generate reactive oxygen species and induce cancer cell apoptosis. This is ongoing in preclinical and early clinical studies.
Restoring p53 therapy
ExperimentaliOngoing in study setting, outcome still unknown
Because many lung cancer tumors have p53 mutations, research is examining how certain natural substances can restore the function of mutated p53. This is still in computational and laboratory stages.
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Choice of treatment per stage
**Early stage (I–II)**
Usually: surgery; after operation possibly adjuvant chemotherapy depending on tumor characteristics.
**Locally advanced (III, resectable)**
Usually: neoadjuvant chemotherapy or chemoradiotherapy, followed by surgery and/or consolidation immunotherapy.
**Locally advanced (III, non-resectable)**
Usually: concurrent chemoradiotherapy, followed by consolidation immunotherapy (durvalumab).
**Advanced (IV)**
Depending on genetic profile:
- No mutation: immunotherapy (PD-1/PD-L1 inhibitor) ± chemotherapy
- EGFR/ALK/ROS1/MET mutation: targeted therapy
- KRAS G12C mutation: targeted inhibitor (under investigation)
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_This information never replaces a doctor's judgment. Always discuss your situation with your own healthcare provider._