Dr. Shuang LI Explains Precision Prevention and Treatment of Lung Cancer

Summary: Early screening and treatment are central to lung cancer prevention and control. Dr. Shuang LI of Shanghai GoBroad Cancer Hospital, Affiliated to China Pharmaceutical University, addresses four questions patients commonly ask. People at higher risk - including those aged 50 or older with a long smoking history, a family history of lung cancer, or long-term exposure to cooking fumes - should pay particular attention to regular low-dose CT screening. Lung cancer treatment has entered an era of increasingly individualized, precision care: pathologic subtype should be established first, followed by molecular testing when appropriate. Treatment options now include targeted tyrosine kinase inhibitors (TKIs), PD-1/PD-L1 immunotherapy, bispecific antibodies, antibody-drug conjugates (ADCs), and other approaches. Clinical trials vary by development stage, and patients can discuss potentially suitable studies with their treating physicians. MDT care brings together specialists from different disciplines to develop an individualized treatment plan and support whole-course management.

Q1: Why is early lung cancer screening so important? Who should pay particular attention to screening, what screening method is recommended, and what should you do if a pulmonary nodule is found?

Dr. Shuang LI: Early screening is one of the most important tools for lung cancer prevention and control. People at higher risk who should be especially alert and consider regular screening include those aged 50 or older, people with a long-term smoking history or significant secondhand-smoke exposure, those with long-term occupational or environmental exposure to carcinogens such as dust or asbestos, and people with a family history of lung cancer in a parent or child. For Chinese women in particular, long-term exposure to cooking fumes may also be an important risk factor to consider. The screening method currently recommended is annual low-dose computed tomography (LDCT). LDCT can identify many pulmonary nodules, but not every nodule is lung cancer. Doctors assess the size and appearance of a nodule and, importantly, how it changes over time to help determine whether it is more likely benign or suspicious for cancer.

If a pulmonary nodule is detected on low-dose CT, it is important to seek medical evaluation promptly so that a specialist can determine whether further testing, surveillance, or treatment is needed.

Q2: What major advances have been made in lung cancer treatment in recent years? What treatment options are now available?

Dr. Shuang LI: Lung cancer has seen a particularly rapid pace of progress over the past two decades, with many new medicines, technologies, and treatment strategies emerging. The first point to understand is that lung cancer is not a single disease. Treatment has moved firmly toward individualized, precision care, which means an accurate diagnosis must come first. Clinically, the first step is to determine the pathologic type - for example, whether the cancer is non-small cell lung cancer (NSCLC) or small cell lung cancer (SCLC). For NSCLC, molecular testing is also important to identify actionable driver alterations that may guide treatment.

Lung cancer treatment now goes far beyond conventional chemotherapy. Options can include small-molecule tyrosine kinase inhibitors (TKIs) for patients with suitable molecular targets, PD-1/PD-L1 immune checkpoint inhibitors, and bispecific antibodies such as PD-1/CTLA-4- or PD-1/VEGF-directed agents. Antibody-drug conjugates (ADCs) have also become an important area of development, including HER2-directed ADCs. Overall, treatment may involve chemotherapy, targeted therapy, immunotherapy, ADCs, anti-angiogenic approaches such as VEGF-directed treatment, bispecific antibodies, and other emerging multi-specific strategies, depending on the individual patient's disease characteristics.

Q3: How should patients understand and evaluate clinical trials? What can participating in a trial mean for them?

Dr. Shuang LI: Clinical trials attract a great deal of interest, but it is important to understand that Phase I, Phase II, and Phase III studies have different purposes. Some trials evaluate new uses of medicines that are already approved and have accumulated substantial safety and efficacy data. These studies may focus on expanding indications, optimizing treatment strategies, or exploring whether a drug can provide benefit in a new clinical setting.

Other trials study medicines before they are approved for routine use and are designed to evaluate their safety and effectiveness in people at different stages of development. For patients considering a clinical trial, an important first step is to understand the question the study is designed to answer. Trials of investigational therapies may explore new targets, new treatment combinations, or innovative medicines, and can provide another potential treatment option for eligible patients.

For most patients and families without a medical background, the best approach is to discuss clinical-trial options directly with the treating physician and identify studies that are genuinely appropriate for the patient's condition. For people with limited standard treatment options, some early-phase studies may provide access to new therapeutic approaches and may also reduce some treatment-related financial burden. Phase III trials may also offer earlier access to newer treatment strategies that have not yet been incorporated into routine clinical guidelines. Whether a trial is suitable should always be assessed on an individual basis.

Q4: This year's Cancer Prevention and Control Awareness Week emphasizes that "integration is key." How does this relate to the multidisciplinary team, or MDT, model?

Dr. Shuang LI: The core idea is that cancer care often requires specialists from multiple disciplines to work together - what we commonly call an MDT approach. Imaging specialists assess radiologic findings, while pathologists establish the pathologic diagnosis, including key molecular pathology results. Surgeons evaluate whether an operation is appropriate and, if so, the best timing. Medical oncologists develop systemic treatment plans, including whether a patient needs neoadjuvant therapy, first-line treatment for advanced disease, targeted therapy, or chemotherapy combined with immunotherapy. If radiotherapy is needed, the team must also decide where it fits into the overall plan and whether the goal is curative or palliative. Other specialists may also be involved when patients have conditions such as chronic obstructive pulmonary disease (COPD), heart disease, or diabetes. By considering the cancer stage together with the patient's overall health and coexisting conditions, the MDT can develop a more complete, standardized, and individualized treatment plan and support whole-course cancer care.

Cancer prevention and treatment cover many different tumor types. Beyond lung cancer, gastrointestinal health also deserves attention, including appropriate screening for gastric disease and cancer and long-term management across the full course of care.