Who this is for
If you or someone close to you has been diagnosed with lung cancer and you are trying to understand whether treatment today is truly different from what it used to be, this is for you.
Ten years ago, advanced lung cancer treatment was much simpler to describe. Most patients received chemotherapy. Some had radiation. A smaller number had surgery. In advanced disease, long-term survival was uncommon.
What has changed is not just that we have more drugs. What has changed is that we now understand that lung cancer is not one disease. It is many different diseases, each driven by different biology.
1. We now look for the driver
One of the biggest changes in lung cancer treatment in Melbourne, Australia, and increasingly across international second-opinion pathways is the routine use of molecular testing. We now look for changes such as EGFR mutations, ALK rearrangements, ROS1, BRAF, MET, RET, KRAS and others, because these can directly change treatment decisions.
This matters because the right treatment is no longer chosen only by where the cancer started. It is chosen by what is driving it.
For example, first-line osimertinib improved median overall survival to 38.6 months in EGFR-mutated advanced non-small cell lung cancer, compared with 31.8 months with older EGFR inhibitors in the FLAURA trial.
In ALK-positive disease, long-term survival has also changed substantially. In the ALEX study, 5-year overall survival was 62.5% with alectinib versus 45.5% with crizotinib, with a hazard ratio for death of 0.67.
So when patients hear that treatment is “more personalised” now, this is what that really means.
2. Immunotherapy has changed the shape of survival
The second major shift has been immunotherapy.
Immunotherapy does not directly poison cancer cells in the way chemotherapy does. Instead, it helps the immune system recognise and attack the cancer. Not every patient benefits, but for some, the benefit can be very durable.
This is the idea I describe elsewhere as “lifting the tail” of the survival curve. The median result may not always capture it well, but a subgroup of patients can do far better than expected for far longer than we used to see.
That has changed how we speak to patients. In the past, discussions were often focused only on averages. Today, in selected patients, there is a realistic conversation about long-term control.
3. Better treatment now depends on better selection
The third shift is that treatment decisions are now more selective.
Instead of giving the same chemotherapy to everyone, we now ask:
• Is there a molecular driver?
• What is the PD-L1 expression?
• Is targeted therapy more appropriate?
• Is immunotherapy likely to help?
• What is the patient’s fitness, pace of disease and treatment priority?
That means two patients with similar scans may receive completely different treatments.
And that is not inconsistency. That is progress.
Why this matters
The most important change in lung cancer treatment over the last 5–10 years is not simply that we have more drugs. It is that we make better decisions because we understand more biology.
That is why waiting for molecular results before starting treatment is often the right decision. It is not delay. It is precision.
For patients in Melbourne, and for those in Sri Lanka, the Philippines, Indonesia and the Maldives seeking coordinated second opinions, this is one of the most important modern principles in lung cancer care: the first treatment choice is often the decision that shapes everything that follows.
Key Takeaway
• Lung cancer treatment has changed because we now test for biological drivers rather than treating all patients the same way.
• EGFR- and ALK-driven cancers are two of the clearest examples of how targeted therapy has extended survival well beyond what was once expected.
• The biggest advance is not just better drugs, but better selection of the right treatment for the right patient at the right time.
Key Evidence
1. Ramalingam SS, Vansteenkiste J, Planchard D, et al. Overall survival with osimertinib in untreated, EGFR-mutated advanced NSCLC. N Engl J Med. 2020;382(1):41-50.
2. Mok T, Camidge DR, Gadgeel SM, et al. Updated overall survival and final progression-free survival data for patients with treatment-naive advanced ALK-positive non-small-cell lung cancer in the ALEX study. Ann Oncol. 2020;31(8):1056-1064.