Twenty years ago, lung cancer treatment was decided by two things: the type of cell and the stage. Chemotherapy was the answer for most people with advanced disease, and it bought months. Today the first question an oncologist asks is what your tumor's genes look like, and the answer can mean a daily pill instead of chemotherapy, or an immune treatment that keeps some people cancer free for years. Five year survival has more than doubled since the 1970s. This guide walks through what is approved for each type and stage, what changed in 2025 and 2026, and where the field is heading.
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First, the tests that now decide your treatment
Before any treatment plan for advanced non small cell lung cancer, guidelines call for two kinds of tumor testing, and their results matter more than stage.
Mutation testing. A panel that checks the tumor for gene changes that drive it: EGFR (about 15 percent of US patients, more in never smokers and people of Asian ancestry), KRAS (about a quarter, with the G12C variant now targetable), ALK, ROS1, BRAF, MET, RET, HER2, and NTRK. Each has at least one approved pill that blocks it.
PD-L1 testing. Measures a protein that predicts how well immunotherapy will work. High PD-L1 often means immunotherapy alone; lower levels usually mean immunotherapy combined with chemotherapy.
If your oncologist has not discussed these results, ask. They determine which medicines and which clinical trials fit you, and many trials will not consider you without them. Our lung cancer page walks through the stages and types in more detail.
Non small cell lung cancer: what is approved
Early stage (I to III). Surgery is the main treatment when the cancer can be removed, and for small tumors in people who cannot have surgery, focused radiation called SBRT works about as well. The big change is what happens around surgery: immunotherapy or chemotherapy given before surgery (neoadjuvant) shrinks tumors and lowers recurrence, and immunotherapy or targeted pills given after surgery (adjuvant) do the same. For people with EGFR mutated early cancer, three years of osimertinib after surgery cut the risk of the cancer returning by about 80 percent in its trial, one of the largest benefits ever shown by a treatment given after lung cancer surgery.
Metastatic disease with a targetable mutation. A pill matched to the mutation, taken daily, usually as the first treatment. EGFR: osimertinib. ALK: alectinib, lorlatinib, and others. KRAS G12C: sotorasib or adagrasib. ROS1, BRAF, MET, RET, NTRK, and HER2 each have approved options. These control cancer for months to years, and when one stops working, next generation versions often follow. In 2025 the FDA approved new drugs for EGFR exon 20 insertions, for HER2 mutations, and for ROS1, and in July 2026 zidesamtinib for ROS1 cancers that progressed on an earlier drug. The mutation list keeps growing.
Metastatic disease without a targetable mutation. Immunotherapy, usually pembrolizumab or a similar checkpoint inhibitor, alone if PD-L1 is high or with chemotherapy if it is not. For a meaningful minority of people, immunotherapy produces responses lasting five years or more, something chemotherapy alone never did.
Antibody drug conjugates, the newest class. These attach chemotherapy to an antibody that seeks out a protein on cancer cells, delivering the drug where it is needed. In May 2025 the FDA approved telisotuzumab vedotin (Emrelis) for non small cell lung cancer with high levels of a protein called c-Met, the first of this class for a lung cancer protein target, and a Phase 3 trial comparing it directly with chemotherapy is recruiting.
Small cell lung cancer: finally moving
Small cell lung cancer, about 15 percent of cases, grows fast, spreads early, and for 30 years was treated with the same chemotherapy with the same disappointing results. That began to change with the addition of immunotherapy to chemotherapy for extensive stage disease in 2019 and 2020. Then in May 2024 came tarlatamab (Imdelltra), a new kind of antibody that grabs a protein called DLL3 on small cell cancer cells with one arm and an immune T cell with the other, pulling them together. It was the first therapy of its kind approved for this disease, and in November 2025 it received full approval after a confirmatory trial in 509 people showed it extended survival compared with chemotherapy. In 2025 a maintenance approach combining immunotherapy with lurbinectedin was approved as well. Small cell lung cancer now has more active trials than at any point in decades.
The screening gap
Here is the number that frustrates lung cancer doctors most. Cancer found at an early stage has a 65 percent five year survival. Cancer found late has about 10 percent. A yearly low dose CT scan finds early cancers in people at high risk, and it is recommended for adults 50 to 80 with a 20 pack year smoking history. Yet in 2024, only about 1 in 5 eligible Americans was screened. An American Cancer Society analysis published in November 2025 estimated that screening everyone eligible would prevent three times as many deaths as current uptake does. If you smoked, or are caring for someone who did, this is the single most consequential conversation to have with a doctor.
What researchers are studying now
Proving the newest drug class. A Phase 3 trial comparing telisotuzumab vedotin with docetaxel chemotherapy in previously treated non small cell lung cancer is the confirmatory study behind the 2025 accelerated approval, and a related study tests the drug alone. This is how accelerated approvals become full ones.
Better KRAS drugs. KRAS G12C was undruggable until 2021. A trial of divarasib with pembrolizumab tests a next generation KRAS G12C blocker combined with immunotherapy as first treatment, and a broader divarasib study tests it alone and in other combinations.
Treatment before surgery, chosen by biomarker. A study of multiple therapies in biomarker selected participants gives people with early stage cancer a targeted or immune treatment before surgery based on their tumor's profile, the direction the whole field is moving.
Surgery versus radiation for small tumors. The JoLT-Ca trial compares removing part of the lung with stereotactic radiation for early stage cancer in older patients, a question that decides how invasive early treatment needs to be.
Small cell lung cancer's new chapter. A study of a new agent in small cell lung cancer and a proton therapy study for small cell disease are part of the wave that followed tarlatamab's approval.
Immunotherapy for the people it fails. A trial of ILKN421H with pembrolizumab in advanced non small cell lung cancer tests whether a second immune drug can help people whose cancer does not respond to checkpoint inhibitors alone.
Finding it earlier. A long running study of lung cancer biomarkers and screening collects blood and imaging to develop tests that could one day find lung cancer before a CT scan can, including in never smokers, who are excluded from current screening.
Why lung cancer research takes time
The many diseases problem. Lung cancer is now a dozen diseases sorted by mutation. Each targeted drug needs its own trial in a small group, and finding enough people with, say, a ROS1 rearrangement (about 1 to 2 percent of cases) takes years and many centers.
The resistance problem. Targeted pills work until the cancer evolves around them, often in one to two years. Much of the pipeline is next generation drugs designed for the specific resistance mutations the last drug created, tested in people who have already progressed.
The late diagnosis problem. Because 43 percent of lung cancer is found late and only 1 in 5 eligible people is screened, most trials enroll people with advanced disease. Screening research, and getting screening to the people who qualify, is as much a research problem as a public health one.
The representation problem. Black Americans are less likely to be screened, diagnosed early, or treated with surgery, and Asian never smokers, who have distinct tumor biology, are underrepresented in US trials. A 2026 research roadmap called for more women, young adults, and never smokers in lung cancer studies. Here's why diversity in clinical trials matters so much.
Common myths about lung cancer
"Only smokers get lung cancer."
Between 10 and 20 percent of people with lung cancer never smoked. Radon, air pollution, secondhand smoke, and gene changes that arise on their own all cause it. Never smokers are more likely to have targetable mutations, which is one reason genetic testing matters.
"If I quit smoking, it is too late to matter."
Risk begins falling within years of quitting and keeps falling. Former smokers who quit decades ago have far lower risk than current smokers, and quitting after a diagnosis improves treatment outcomes. Our smoking cessation studies page lists research that can help.
"Stage IV means a few months."
Not for many people anymore. Metastatic five year survival rose from 2 percent to 10 percent in a decade, and for people with a targetable mutation or a strong immunotherapy response, living several years with good quality of life is now common.
"Chemotherapy is the only real option for advanced disease."
For most people with advanced non small cell lung cancer today, the first treatment is a targeted pill or immunotherapy, sometimes with no chemotherapy at all. Chemotherapy still matters, but it is one tool among several.
The stages, and what care usually looks like
Stage I is usually surgery or focused radiation, sometimes followed by a targeted pill or immunotherapy. Stage II and III combine surgery, chemotherapy, radiation, and immunotherapy or targeted therapy before or after surgery, and for cancers that cannot be removed, chemotherapy plus radiation followed by immunotherapy. Stage IV depends on testing: a targeted pill if there is a driver mutation, immunotherapy with or without chemotherapy if there is not, and antibody drug conjugates or second line options after progression. Small cell lung cancer follows its own path: chemotherapy plus immunotherapy, radiation for limited stage, and tarlatamab after progression. This is a description of usual practice, not a recommendation, and your plan belongs to you and your oncologist.
For trials, type, stage, and mutation are the headline in nearly every title. Your pathology and genetic test reports let you filter studies in minutes.
How to find a lung cancer clinical trial
AllClinicalTrials.com lists lung cancer studies recruiting across the US, from screening and surgery trials to Phase 3 drug trials and biomarker research. Two examples recruiting right now: the divarasib plus pembrolizumab trial for people with KRAS G12C mutated non small cell lung cancer, and the JoLT-Ca trial comparing sublobar surgery with stereotactic radiation for early stage disease.
The application takes about 5 minutes: you answer questions about your type, stage, mutation results, and treatments so far, and if a study near you looks like a match, the research team contacts you. Nothing is decided until you have gone through informed consent, and participation is voluntary at every step. Three things to have ready: your type and stage, your tumor's genetic test and PD-L1 results, and the list of treatments you have had.
Common questions
What is the newest treatment for lung cancer? In 2025 the FDA approved telisotuzumab vedotin (Emrelis), the first antibody drug conjugate for c-Met high non small cell lung cancer, along with new targeted drugs for EGFR exon 20, HER2, and ROS1 mutations. In July 2026 zidesamtinib was approved for ROS1 cancers that progressed on earlier treatment.For small cell lung cancer, tarlatamab (Imdelltra) was the first DLL3 targeted T-cell engager approved, in May 2024, and it received full approval in November 2025.
What is the survival rate for lung cancer? Overall five year relative survival is about 28 percent, more than double the 12 percent of the 1970s. For cancer confined to the lung it is about 65 percent; for late stage disease about 10 percent, up from 2 percent a decade earlier. These are population figures, not predictions for any individual, and depend heavily on type, mutations, and treatment response.
Can stage 4 lung cancer be cured? Generally not with current treatment, but it can often be controlled for years. Some people with high PD-L1 who respond to immunotherapy remain cancer free more than five years later, and people with targetable mutations frequently live several years on sequential targeted pills. Long term survivors of stage IV lung cancer were nearly unheard of 15 years ago.
See clinical trials for lung cancer recruiting now
Browse open studies, filter by location, and apply in about 5 minutes: Lung Cancer Clinical Trials