Synopsis
Integrate histology, TNM stage, predictive biomarkers, physiological fitness and patient priorities to select curative local therapy, multimodality treatment or personalised systemic care.
- Non-small-cell lung cancer includes adenocarcinoma, squamous carcinoma and less common subtypes; histology influences sampling, biomarker testing and systemic therapy.
- Treatment is organised by TNM stage, anatomical resectability, cardiopulmonary fitness, performance status, molecular drivers, PD-L1 expression and the person's goals.
- Early resectable disease is considered for anatomical lung resection with systematic nodal assessment; medically inoperable disease may be treated with stereotactic ablative radiotherapy or another radical schedule.
Key red flags
New focal deficit, seizure, cord-compression features, severe hypercalcaemia, major haemoptysis or superior vena cava obstruction needs emergency treatment alongside oncological reassessment.
Investigation priorities
Confirm NSCLC subtype and adequacy for predictive testing.
Management branches
NSCLC appears confined to the lung and regional nodes with no confirmed distant disease.
- Complete PET-CT, appropriate mediastinal staging and physiological assessment, verifying any solitary finding that would remove curative intent when feasible.
- For operable resectable disease, discuss anatomical resection and systematic nodal assessment with thoracic surgery, incorporating minimally invasive approaches when appropriate.
Key medicines
OsimertinibOral once-daily specialist regimen according to current SmPC and funded NICE indication.
PembrolizumabIntravenous fixed-dose schedule administered by oncology according to the licensed regimen.