Targeted Therapies Are Transforming Lung Cancer Treatment

At a recent CURE Educated Patient® Lung Cancer Summit, held in tandem with the 2025 PER® New York Lung Cancer Symposium, Dr. Catherine A. Shu provided an in-depth discussion on targeted therapies for lung cancer, emphasizing advances, challenges and the importance of clinical trials.

Shu is a board-certified medical oncologist, and she serves as the Price Family Associate Professor of Medicine and is an associate professor of medicine at New York-Presbyterian / Columbia University Irving Medical Center, where she is also the clinical director of Thoracic Medical Oncology Service.

Shu emphasized the overall progress in lung cancer treatment, stating, “We have so many new medications … and the medications work. Patients are living longer. That’s the most important thing.” While her focus was on targeted therapies, many of the principles she discussed apply broadly to lung cancer treatment strategies, reinforcing the growing potential to improve patient outcomes.

Understanding Lung Cancer in Never-Smokers and Young Patients

A significant portion of Shu’s talk focused on lung cancer in patients who have never smoked. She explained that lung cancers which occur in never-smokers exhibit distinct biological and clinical characteristics compared with smoking-related lung cancers. These cancers are more common among women and show geographic variation, particularly in Southeast and East Asia.

“Probably about 25% of lung cancers are seen in never smokers,” she explained. “There’s a distinct difference between the never smoking cancers and the smoking-related cancers. A lot of times, people come to me and they’re like, ‘I don’t know how it’s possible. How do I develop a lung cancer? I’ve never smoked in my life.’ It’s not just about smoking. These cancers act differently.”

Never-smoker lung cancer remains a major challenge due to the lack of screening and late-stage diagnoses. Shu highlighted that many patients experience symptoms like persistent cough for months before seeking evaluation, delaying treatment. Ongoing studies, such as a screening trial at NYU targeting Asian women who have never smoked, may help identify lung cancer earlier and influence future screening guidelines.

Young patients with lung cancer often share these characteristics. Shu noted that the youngest patients may be diagnosed as teenagers, and smoking is not a contributing factor in these cases. These cancers tend to be adenocarcinomas and are often driven by targetable mutations, reflecting a unique biology that differs from traditional lung cancers.

The Role of Targeted Therapies and Molecular Testing in Lung Cancer

Targeted therapies are treatments designed to act on specific genetic changes in cancer cells. Molecular testing is critical in identifying mutations and guiding therapy selection. Shu emphasized the importance of precise diagnoses, explaining that patients need to know not only their lung cancer type but also the exact mutation, such as EGFR exon 20, because these details drive both treatment and prognosis.

Clinical examples demonstrated the remarkable effects of targeted therapies. One patient with EGFR-positive lung cancer showed near-complete resolution on imaging within a month of starting therapy. Another patient with ALK-positive cancer experienced significant tumor shrinkage within two weeks. Shu reflected on the progress, saying, “If you think about where we were 30 to 40 years ago, to imagine that some metastatic lung cancer could look like this a month later… it’s mind boggling.”

Targeted therapies offer several advantages, including fewer side effects compared with chemotherapy, oral administration and personalization based on tumor genetics. However, resistance mutations can develop over time, meaning patients may need to transition to new therapies after several years. Shared decision-making between patients and clinicians is essential, taking into account both tumor characteristics and personal preferences.

Managing Progression in Lung Cancer and Expanding Clinical Trial Opportunities

In some cases, cancer may progress in a limited area, a scenario known as oligo-progression.

“Sometimes we can use local therapies like radiation or surgery, and then continue you on the same pill. That can buy another five years on that therapy, where you’re living your life fully.” When systemic progression occurs, additional testing, such as tissue or liquid biopsies, can help guide subsequent therapy or enrollment in clinical trials. “All of these new medications we’ve found have been through clinical trials,” she explained. “If you have a chance to participate, it’s a great opportunity to help further science and medicine.”

Shu underscored the importance of patient participation in clinical research, noting that many of the newest therapies are only available through clinical trials. These studies provide opportunities for patients to access cutting-edge treatments while contributing to advances in medical knowledge.

Targeted Therapy in Early-Stage Lung Cancer

Beyond metastatic disease, targeted therapies are increasingly being evaluated in early-stage lung cancer. Studies have shown improved survival with adjuvant therapies, including Tagrisso (osimertinib) for EGFR-positive patients and Alecensa (alectinib) for ALK-positive patients following surgical resection. Ongoing research continues to explore whether targeted therapy alone may be sufficient for some patients, potentially reducing or replacing the need for chemotherapy in certain settings.

Acknowledging Progress, Patients and Caregivers

Shu concluded her presentation by recognizing the collective effort behind the advances in lung cancer treatment. She expressed gratitude for physicians, scientists, patients, caregivers, advocacy groups and clinical trial participants who have contributed to progress over the last two to three decades. She also highlighted the essential role of caregivers, noting the demands and challenges they face.

Shu’s presentation underscored the transformative impact of targeted therapies on lung cancer outcomes, the importance of molecular testing for personalized treatment, and the ongoing need for patient involvement in clinical trials. Her insights offer hope for improved survival, earlier detection, and enhanced quality of life for patients navigating lung cancer.

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