World Lung Cancer Day: Experts Offer New Hope for Screening and Emerging Treatments

Lung cancer remains the leading cause of cancer-related death globally, responsible for nearly 1.8 million deaths annually, more than the next leading 2 combined (colorectal and liver cancer). Despite longstanding advancements in other cancers, lung cancer’s prognosis has lagged, in large part due to late-stage diagnoses.1

On World Lung Cancer Day, HCPLive is spotlighting advances in detection, screening access, and therapeutic innovation featuring insights from expert interviews featured on Lungcast, the American Lung Association’s monthly podcast series hosted by their CMO, Albert Rizzo, MD, in partnership with HCPLive.

Lung cancer outcomes hinge on timely diagnosis, a hurdle that scientists, clinicians, and health systems are becoming increasingly equipped to overcome. Lately, a convergence of innovation in early detection, evolving screening infrastructure, and next-generation therapies has begun to shift the trajectory of lung cancer care.

Screening: From Missed Opportunity to Missed Diagnoses

Low-dose CT (LDCT) screening for high-risk patients has long been proven to reduce mortality. A decade after the pivotal National Lung Screening Trial (NLST) showed a 20% reduction in lung cancer mortality among high-risk smokers screened with LDCT, implementation still trails behind expectations.2 Only a fraction of eligible individuals undergo annual scans, a reality that public health experts say stems from systemic, social, and logistical barriers.3

Mary Pasquinelli, DNP, who directs the lung screening program at UI Health in Chicago, sees this challenge firsthand. “Despite all the evidence we have, too many patients fall through the cracks,” she said. “We know we can reduce lung cancer mortality by 20 to 25% with screening. We just have to get them screened.”

At her institution, a hybrid screening model that combines centralized coordination with primary care integration has helped reverse these trends. Pasquinelli’s team proactively monitors LDCT orders, reaches out directly to patients, and ensures adherence with follow-up scans and consultations. The result: an optimal adherence rate of 71%, with over 85% of patients returning for repeat scans within 24 months—a stark contrast to the national average return rate of 30 to 40%.2

Barriers like transportation and stigma are being tackled head-on. “Through a grant from the American Lung Association, we provide free transportation via Uber Health and parking vouchers. That eliminates a barrier for many patients who might otherwise not come,” she explained.

Still, Pasquinelli points out that while recent USPSTF guideline changes lowered the age and pack-year thresholds, many patients who develop lung cancer still wouldn’t qualify under current rules.4

“We’re not capturing all of those people who are getting lung cancer. We know from the data that Black patients smoke differently and have higher rates of lung cancer.”

Biomarkers and Blood Tests: A Future of Accessible Screening

While LDCT remains the gold standard, a new frontier in early detection is emerging: liquid biopsy biomarkers. Blood-based assays capable of detecting cancer-specific DNA fragments, proteins, or RNA are increasingly making their way into the clinic.

“There are so many signals these tests can analyze—circulating tumor DNA, methylation patterns, even how DNA fragments break apart,” explained Lindsey Cotton, DOMed, DHSc, MS, a clinician scientist and early cancer detection expert who has worked at companies like Grail and Guardant Health. “It’s like being a detective. If you only look for fingerprints, you might miss a break-in where gloves were used. But if you check DNA, footprints, and security footage together, you're less likely to miss the crime. That’s how we should approach cancer detection.”

Multi-cancer early detection (MCED) tests and organ-specific panels show promise, particularly for cancers without established screening programs.5 But the challenges are substantial: false positives can lead patients into a “diagnostic wilderness” of follow-up testing, uninsured procedures, and anxiety. False negatives, especially for a fast-moving cancer like lung cancer, can be deadly.

“A test might boast 85% sensitivity overall, but when you dig into the data, it’s only 40% sensitive in stage I disease,” Cotton said. “That means you’re missing 60% of the earliest, most curable lung cancers.”

Coverage and regulatory clarity are also murky. Most of these tests are offered as laboratory-developed tests (LDTs), governed by CLIA and CAP accreditation but not always approved by the FDA. Some developers seek FDA approval to enable guideline inclusion and third-party payer coverage—key steps to real-world adoption.5

Still, Cotton is optimistic: “The science is rapidly advancing, and the goal is clear—detection at the earliest, most treatable stage.”

Integrating Screening Into Patient Conversations

As programs like Pasquinelli’s demonstrate, integrating screening into routine care requires more than guidelines—it requires trust. Her program includes comprehensive shared decision-making visits, often the first point of education for patients facing lung cancer risk.

“Many of my patients are anxious. They feel shame about smoking, or they fear what we’ll find,” she said. “But I sit down and explain what pulmonary nodules are, what the scan does and doesn’t show, and that most findings are benign. When they understand that, they almost always go forward.”

She adds that showing patients their scans can be a powerful moment: “I show them the emphysema in their lungs—holes that can’t be fixed, but can be prevented from worsening. It’s visual, it’s personal, and it changes the conversation.”

The program also provides smoking cessation support. “It’s not just about quitting to reduce lung cancer risk—it improves outcomes in people who already have cancer. Treatment works better, survival improves, and risk of secondary cancers goes down,” she said.

Treating Small Cell Lung Cancer: A Tenuous Progression

While non-small cell lung cancer (NSCLC) has benefited from targeted therapies and checkpoint inhibitors, small cell lung cancer (SCLC)—about 15% of all lung cancers—has long resisted durable treatments. Its hallmark is rapid growth and early metastasis, particularly to the brain.6

Jacob Sands, MD, thoracic oncologist at Dana-Farber Cancer Institute, knows this battle well. “We now have a clearer staging system, with limited stage meaning disease that fits within a radiation field, and extensive stage meaning it's spread beyond,” he said. “But historically, even limited stage disease had poor outcomes.”

Data has begun to show a potential shift in this trend. Notably, the ADRIATIC trial demonstrated that adding durvalumab, an immunotherapy agent, after chemoradiation improved median overall survival by over 22 months.7

]“We're seeing three year overall survival that's over 40%, close to half of people, which is a pretty incredible improvement,” Sands said.

Meanwhile, for patients with extensive-stage disease or those who relapse, options remain limited but are growing. Two newer agents in particular, lurbenectedin and tarlatamab, are showing promise.

Lurbenectedin, approved in the second-line setting, has a response rate of 35% and better tolerability than previous chemotherapy agents.

“Patients aren't losing their hair and they're not feeling quite as sick. It's not a cure, but it's meaningful,” Sands said.

Tarlatamab, a bi-specific T-cell engager targeting DLL3 and CD3, offers even more excitement. With a response rate of 40% in heavily pretreated patients and some maintaining response for over a year, Sands sees this as a breakthrough, although one with caveats.8 “The first 2 doses are required to be given in the hospital because of cytokine release syndrome… [but] it has the potential for really meaningful durability of response.”

Reconsidering the Brain: Rethinking Radiation

One of the most challenging aspects of SCLC management has been brain metastases. Historically, prophylactic cranial irradiation (PCI) was standard, but recent data suggests that with modern imaging, the benefits may be overstated.

“In those studies, the patients did not get MRIs. So it's possible that they were being treated for already existing disease that we didn't know was there,” Sands said.

The MAVERICK trial, currently underway, aims to settle that question. Until then, Sands sees a trend toward MRI surveillance rather than preventive whole-brain radiation.

Where We’re Headed

The future of lung cancer care hinges on two intertwined forces: broadening the reach of proven tools like LDCT screening, and accelerating the adoption of new diagnostics and therapies that catch and treat lung cancer earlier and more effectively.

Cotton, Pasquinelli, and Sands all agree: equity in access will be key.

“We're finally seeing options that are meaningful, and it's changing how we talk to patients about what's next,” Sands said.

REFERENCES

1. World Health Organization. Cancer Fact Sheet. World Health Organization. Updated February 2022. Accessed July 31, 2025. https://www.who.int/news-room/fact-sheets/detail/cancer

2. National Lung Screening Trial Research Team. Reduced lung-cancer mortality with low-dose computed tomographic screening. N Engl J Med. 2011;365(5):395–409. doi:10.1056/NEJMoa1102873

3. Triplette M, Clark JM, Bird D, et al. Perceptions of low-dose CT screening for lung cancer among smokers: a qualitative study. JAMA Netw Open. 2020;3(1):e1918940. doi:10.1001/jamanetworkopen.2019.18940

4. Darden ME, Hoagland A. Lung Cancer Screening and USPSTF Recommendations. JAMA Network Open. 2025;8(2):e2458916-e2458916. doi:https://doi.org/10.1001/jamanetworkopen.2024.58916

5. ‌Liu MC, Oxnard GR, Klein EA, et al. Sensitive and specific multi-cancer detection and localization using methylation signatures in cell-free DNA. Ann Oncol. 2020;31(6):745–759. doi:10.1016/j.annonc.2020.02.011

6. American Cancer Society. Key Statistics for Lung Cancer. Updated January 2024. Accessed July 31, 2025. https://www.cancer.org/cancer/lung-cancer/about/key-statistics.html

7. AstraZeneca. Imfinzi improved overall survival in patients with limited-stage small cell lung cancer in ADRIATIC Phase III trial. Press release. Published June 2024. Accessed July 31, 2025. https://www.astrazeneca.com/media-centre/press-releases/2024/durvalumab-improves-os-in-small-cell-lung-cancer.html

8. Spira AI, Lisberg AE, Sands J, et al. Tarlatamab, a DLL3-targeted T-cell engager in recurrent small-cell lung cancer. N Engl J Med. 2023;389(15):1395–1406. doi:10.1056/NEJMoa2306426