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  • Lung cancer is the leading cause of cancer-related death in the United States. However, patients with early lung cancer have lower lung cancer–related mortality, and screening with low-dose computed tomography in high-risk groups correlates with a reduction in overall mortality.

  • Multidisciplinary evaluation, including early integration of palliative care, for patients with locally advanced or metastatic non–small cell lung cancer (NSCLC), improves patient outcomes and quality of life.

  • Immune checkpoint therapies, particularly therapies targeting the programmed cell death protein 1–programmed cell death ligand 1 pathway are now the standard (as a single agent or as a part of combination) therapy for first-line treatment of metastatic NSCLC that does not harbor targetable mutations and should be considered for all patients if there are no contraindications.


Lung cancer is the second most common cancer in women (after breast cancer) and in men (after prostate cancer) but is the most common cause of cancer-related death.1 Every year, more than 1.7 million patients die of lung cancer worldwide.2 About 70% of patients are diagnosed in advanced stages of disease, when the probability of cure is low. Over the years, lung cancer screening efforts and technological advancements in imaging studies have increased the detection of lung cancer in earlier stages; advances in minimally invasive techniques for diagnosis, radiation therapy, and multimodality approaches in locally advanced disease in non–small cell lung cancer (NSCLC) have improved clinical outcomes. Furthermore, in the metastatic setting, advances in targeted therapies in patients with actionable mutations and introduction of immune checkpoint inhibitors (ICIs) used as single agents or in combination have contributed to significant improvements in overall survival (OS). The eventual survival of a patient depends on factors such as presence or absence of comorbidities, stage, tumor characteristics, and performance status as discussed in this chapter.

Lung cancer is broadly divided into small cell lung cancer (SCLC) and NSCLC. Approximately 85% of lung cancers are NSCLC. This chapter describes the epidemiology, etiology, histology, prevention, and molecular biology of NSCLC. The multidisciplinary management of stages I to III is described followed by treatment of stage IV NSCLC without an oncogene driver. Chapter 25 focuses on treatment of patients with NSCLC with a targetable mutation. We will review current clinical knowledge in these areas, with an emphasis on our approach at the University of Texas MD Anderson Cancer Center (MDACC).


Lung cancer is rarely diagnosed in people younger than 35 years old. Indeed, the median age for lung cancer in the United States in 70 years of age. Incidence and death rates rise exponentially until age 75 years, when a plateau is reached. NSCLC accounts for the greatest number of deaths from cancer in both men and women over age 60 years.

The geographic, social, and temporal trends of the incidence of NSCLC are closely related to tobacco consumption. In developed Western countries, ...

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