Lung Cancer Survival: Perioperative Treatment Impact

iSanidad Yearbook 2025
Nieves Sebastian Mongares
Taking into account that lung cancer has been a disease linked to a poor prognosis, the arrival in recent years of alternatives that complete the therapeutic arsenal has been a turning point in the course of the disease for many patients.

Thanks to these new treatments, as well as new strategies, as explained by Dr. Margarita Majem, associate physician Medical Oncology Service at Hospital de la Santa Creu i Sant Pau, in this interview conducted with the support of BeOne The survival of these patients has been significantly improved. However, there are still pending challenges, such as the implementation of screening programs for this neoplasia to continue improving the numbers in the different subtypes of lung cancer.

What assessment do you make of the advances and challenges in lung cancer during 2025?
Lung cancer, historically, has been a very aggressive disease with very low survival. But it is true that in recent years there have been several findings both in non-small cell lung cancer (NSCLC), with the appearance of targeted therapies or immunotherapy, and in small cell lung cancer, which is where most progress has been made lately, especially with new first-line treatments in combination with standard treatment and tumor progression.

It should be noted that, in NSCLC where there is currently more development, it is at the local level with neoadjuvant and adjuvant therapies, especially in patients with molecular alterations. Then, also with immunotherapy in patients without treatable mutations.

If you had to point out one misconception about lung cancer that still weighs heavily on society, what would it be and why is it important to dismantle it today?
I think we always have the mantra that anyone who has lung cancer has it because they asked for it. It is true that tobacco is the cause of a large part of lung cancer cases and is an easily avoidable risk factor. But there is also another point, and that is that it could be detected in time with screening programs that, at the moment, are not established in the healthcare system. Furthermore, it should be noted that there is a percentage of patients who are non-smokers and have also developed lung cancer.

Lung cancer continues to be diagnosed, in many cases, late. Beyond clinical symptoms, what cultural, social or structural barriers continue to delay diagnosis? What is your view on screening and the impact it could have?
Of course, these barriers still exist. Many times, in these non-smoking patients, their symptoms are confused with those of respiratory infections or other conditions. And, as I mentioned, in smoking patients, if there were screening programs implemented, they would allow many cases to be diagnosed in localized stages, which is when these tumors are curable. When diagnosed in more advanced stages, cure is difficult to achieve.

If there were screening programs implemented, they would allow many cases to be diagnosed in localized stages, which is when these tumors are curable.

The advent of immunotherapy and targeted treatments has transformed disease management. What advances have made a more tangible change in the daily lives of your patients, beyond survival data?
Thanks to immunotherapy, there are patients with metastatic lung cancer, even with brain metastases, who can achieve cure. Specifically, there are studies in which immunotherapy has been applied for two years and, after completely stopping the treatment, the patient does not progress again. Then, there are other patients in whom treatments are administered until progression, but they have been on this therapy for five or six years and it can be said that they are cured.

In localized stages, but also in advanced disease, targeted therapies have very substantially improved survival, so that there are patients who have a survival of 60% at five years, with some specific molecular alterations, for which they receive a specific targeted treatment. However, it should be noted that the important thing is to demonstrate or find that mutation, which is why it is essential to perform molecular studies on our patients.

In cases where targeted therapies can be administered, they continue to be oral treatments, which perhaps gives the patient more freedom because they do not have to come to the hospital as much, also providing an improvement in efficacy and toxicity, because these are better tolerated than chemotherapy. This applies to both localized and metastatic disease. Immunotherapy also has a much better safety profile, making the quality of life of patients who receive it much higher than that of chemotherapy.

Immunotherapy also has a much better safety profile, making the quality of life of patients who receive it much higher than that of chemotherapy.

We are increasingly talking about treating lung cancer in earlier stages. What is the perioperative approach contributing to non-small cell lung cancer and why is this moment in the therapeutic process key to changing the prognosis?
Thanks to perioperative treatments, especially with the induction phase, it has been shown that this strategy has a high impact on patient survival. Thus, those patients who receive chemoimmunotherapy before surgery and immunotherapy after the intervention have a higher survival than patients who have only received neoadjuvant therapy.

Those patients who receive chemoimmunotherapy before surgery and immunotherapy after the intervention have a higher survival than patients who have only received neoadjuvant therapy.

Also, we began to see patients with tumors borderline in which resectability was very doubtful but, thanks to neoadjuvant treatment, we managed to achieve a complete resection of the tumors, which also shows a complete pathological response. In short, what neoadjuvant therapy has demonstrated is an impact on patient survival and, also, on the resectability of these tumors.

In a context of constant innovation, how is the speed in incorporating new treatments balanced with the need to guarantee the best possible use of available resources?
Currently, treatments are not incorporated quickly in Spain; There is a very significant delay in approvals. There are many treatments that are either approved by the European Medicines Agency (EMA) or by the US regulatory agency (FDA), which are not yet authorized in Spain, which is a resource issue.

So, the authorizations are arriving slowly and what we are seeing is that, in treatments with efficacy on a very discrete sample, the approval does not arrive, because in the overall count of patients it does not compensate that only two or three can benefit from innovative options.

So, we see that there are treatments with a clear impact on survival in clinical trials and a clinically significant benefit, which may seem less relevant for this reason and are not approved. Clinical trials and expanded uses are the way we currently access these treatments in most hospitals. There are treatments with proven scientific evidence that we cannot use if not through these mechanisms.

Clinical trials and expanded uses are the way we currently access these treatments in most hospitals.

Beyond oncological treatment, what aspects of support for patients with lung cancer continue to be underrepresented or poorly addressed in the health system?
I would say that the most important is the one related to smoking cessation. But also, psychological, nutritional support and that related to physical exercise. All of these are measures that have shown a significant impact on the quality of life of patients, but measures such as physical exercise can also have a positive impact on survival and continue to be part of the unmet needs.

Many times it is the associations that cover these needs, such as the Spanish Association of Lung Cancer Patients (Aeacap) or the Spanish Association against Cancer (AECC). These have psycho-oncology or physical exercise programs that cover an aspect that represents a significant deficit.

This last year has been especially dynamic in lung cancer. If you had to define the current moment of pathology in Spain with a single word, which one would you choose and why?

Innovation, because we have more and more new treatment alternatives and I believe that innovation is what is helping us to really improve the survival of our lung cancer patients.