When Can Lung Cancer Be Cured?

Understanding Cancer and What “Cure” Really Means

Before diving into the breakthroughs, let’s clarify what cancer is—and what we mean by “cure.” Most definitions focus on how cancer begins, but it’s just as important to understand how it behaves once established. Cancer is a tissue made up of cells that have dramatically changed their behaviour compared to the healthy cells they originated from. In lung cancer, for example, normal lung cells stay put, produce mucus, and help us breathe. Cancer cells, however, hijack the genetic playbook normally reserved for embryonic development—allowing them to grow rapidly, spread to other organs, and consume vast amounts of energy. This often leads to weight loss, fatigue, and loss of appetite—red flags that alert clinicians to the possibility of cancer.

These symptoms are uncommon in early-stage lung cancer, which is why screening is so powerful. By catching cancer early, we can offer treatments with curative intent.

Historically, “cure” has meant no evidence of cancer on scans for five years or more. But that definition is evolving. I now have patients who presented with widespread lung cancer—affecting the liver, bones, even the brain—who responded so well to immunotherapy that their scans have remained clear for nine years. They meet the definition of cure despite receiving treatment with palliative intent. Still, I do not dare to let them go from our follow-up programme. We had never seen this before immunotherapy became part of our toolkit.

The Power of Early Detection and Multimodal Treatment

Where we’re mainly seeing increasing cure rates is in early-stage lung cancer. These cancers haven’t spread to distant organs, though they may involve nearby lymph nodes. If the patient is fit for surgery, the tumour can often be removed. Some patients are cured with surgery alone, but if the tumour is large or lymph nodes are involved, the risk of recurrence within five years can exceed 50%. When I contributed to writing the European oncology guidelines in 2017(1), the only oncology option we had then was chemotherapy before or after surgery, with a very small impact on patient survival. But this has changed now.

To reduce that risk, we can offer chemotherapy followed by immunotherapy after surgery. But that is not the most effective approach. Giving both treatments, chemotherapy and immunotherapy together before surgery, is better tolerated (in my own experience) and is the approach that has been proven to give the best outcomes in patient survival. This “neoadjuvant” strategy can lead to a complete pathological response in nearly one in four patients, meaning no cancer cells are found when the tumour is examined under the microscope after removing the piece of lung where it was once located. In clinical trials, we have seen that giving chemotherapy alone before surgery, recurrence rates remain at 55%. But if we give neoadjuvant chemo-immunotherapy combination the chance of recurrence drops significantly to around 35% at 3 years (2). These results are similar to our own results in Liverpool, which we have published together with other European centres (3). Some patients will also benefit from having further immunotherapy alone after they have recovered from surgery. This immunotherapy is, in general terms, much better tolerated than chemotherapy, but not devoid of risk of side effects; patient selection is key (4).

For patients with non-small cell lung cancer driven by EGFR mutations, targeted tablet therapies are showing promise. In the large World-Wide NeoAdaura study I co-authored (5), nine weeks of targeted treatment before surgery led to significantly higher complete response rates compared to chemotherapy alone. Despite the exciting results, survival data is still awaited, and my guess is that it will be years before the NHS considers approving funding for this approach.

Raising the Bar for Private Cancer Care

I published a scientific review on these developments a few years ago (6), and the evidence continues to grow. In the private sector, more drugs are licensed but not always funded by public health systems. Unfortunately, private care in the UK isn’t always as multidisciplinary as the NHS, which means patients with potentially curable disease may undergo surgery without receiving chemo-immunotherapy beforehand, although this may have been the most effective combination of treatments for that patient.

That’s why we’ve established a dedicated multidisciplinary service at the Clatterbridge Clinic in Liverpool for private patients with early-stage lung cancer. Together with Mr Julius Assante-Shaw, a leading thoracic surgeon, we ensure that patients receive the best possible curative treatment plan. When a patient is referred to either of us, we review the scans jointly and offer a shared consultation. When appropriate, the three of us—patient, surgeon, and oncologist—create a personalised plan and support the patient every step of the way. The best care is collaborative and open-minded, and this approach helps us use the best and most up-to-date treatments for each patient.

If you have been diagnosed with early-stage lung cancer and you’d like to find out if you can access curative treatment and explore treatment options, feel free to reach out to us at the following email address:

ccf-tr.cccreferrals@nhs.net

REFERENCES:

1. (1) Postmus PE, Kerr KM, Oudkerk M, Senan S, Waller DA, Vansteenkiste J, Escriu C, Peters S; ESMO Guidelines Committee. Early and locally advanced non-small-cell lung cancer (NSCLC): ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2017 Jul 1;28(suppl_4):iv1-iv21. doi: 10.1093/annonc/mdx222. PMID: 28881918.
2. (2) Forde PM, Spicer JD, Provencio M, Mitsudomi T, Awad MM, Wang C, Lu S, Felip E, Swanson SJ, Brahmer JR, Kerr K, Taube JM, Ciuleanu TE, Tanaka F, Saylors GB, Chen KN, Ito H, Liberman M, Martin C, Broderick S, Wang L, Cai J, Duong Q, Meadows-Shropshire S, Fiore J, Bhatia S, Girard N; CheckMate 816 Investigators. Overall Survival with Neoadjuvant Nivolumab plus Chemotherapy in Lung Cancer. N Engl J Med. 2025 Aug 21;393(8):741-752. doi: 10.1056/NEJMoa2502931. Epub 2025 Jun 2. PMID: 40454642.
3. (3) Brunelli A, Mariolo A, Aigner C, De Antonio DG, Jimenez M, Hemead H, Hoffman R, Lodhia J, Nardini M, Mattioni G, Sinn K, Hoda MA, Novoa N, Davila GR, Gomez-Hernandez MT, Rivas-Duarte C, Bhatnagar P, Clarke K, Escriu C, Fakih O, Franks K, Bouaziz K, Calvo V, Sereno M, Provencio M, Girard N, Shackcloth M. Surgical Results after Neoadjuvant Nivolumab and Platinum-based Chemotherapy for Resectable Lung Cancer. A Multicentre European Real Clinical Practice Analysis. Eur J Cardiothorac Surg. 2025 Oct 2;67(10):ezaf343. doi: 10.1093/ejcts/ezaf343. PMID: 41093743.
4. (4) Rossi G, Barcellini L, Tagliamento M, Tanda ET, Garassino MC, Blondeaux E, Delucchi V, Spagnolo F, Del Mastro L, Genova C. Immunotherapy for resectable NSCLC: neoadjuvant/perioperative followed by surgery over surgery followed by adjuvant. Systematic review and meta-analysis with subgroup analyses. ESMO Open. 2025 Sep;10(9):105759. doi: 10.1016/j.esmoop.2025.105759. Epub 2025 Sep 5. PMID: 40913837; PMCID: PMC12451348.
5. (5) He J, Tsuboi M, Weder W, Chen KN, Hochmair MJ, Shih JY, Lee SY, Lee KY, Nhung NV, Saeteng S, Liu L, Xing L, Gia NH, Murakami S, Han Y, Saavedra MP, Yoon SH, Teixeira CHA, Escriu C, Martinez-Marti A, Blakely CM, Yatabe Y, Dacic S, Rukazenkov Y, Huang X, Dayal A, Chaft JE; NeoADAURA Investigators. Neoadjuvant Osimertinib for Resectable EGFR-Mutated Non-Small Cell Lung Cancer. J Clin Oncol. 2025 Sep 10;43(26):2875-2887. doi: 10.1200/JCO-25-00883. Epub 2025 Jun 2. PMID: 40454705.
6. (6) Escriu C. Role and evidence for targeted therapies in surgically resectable non-small cell lung cancer: a narrative review. VATS June 2022 doi: 10.21037/vats-21-39