{"entity":{"id":"lung-cancer-evidence-roadmap","kind":"roadmap","name":"Lung cancer roadmap: from Doll and Hill and the naming of tobacco, through the cytotoxic plateau, computed tomography screening, EGFR and ALK, immunotherapy by PD-L1, the perioperative trials and PACIFIC, to DLL3 in small-cell disease and a 2032 registry watch","aka":["Lung cancer history","Lung cancer evidence roadmap","NSCLC and SCLC roadmap","Thoracic oncology roadmap"],"tldr":"Lung cancer is where modern cancer epidemiology began: two studies in 1950 tied it to cigarettes, and a fifty-year cohort proved it. This roadmap follows the evidence from there through chemotherapy that barely worked, the scans that find the disease early, the drugs for cancers that depend on one broken gene, immunotherapy, and small-cell disease, to 2032.","summary":"Lung cancer kills more people than any other cancer, and it is the cancer whose cause is best understood. Wynder and Graham in the United States and Doll and Hill in Britain published within months of each other in 1950; the British Doctors Study then followed a cohort for fifty years and turned an association into a dose-response relationship with a cessation curve attached. Peto's 2000 analysis gave the number that tobacco control still runs on: stopping before middle age avoids more than 90 percent of the risk.\n\nTreatment took much longer. The 1995 individual-patient meta-analysis of 52 trials showed cisplatin-based chemotherapy helped, by about 5 percent at five years after surgery; E1594 in 2002 showed that no combination of cytotoxic drugs beat any other, with a median survival of 7.9 months. The plateau broke twice. In 2004 Lynch and Paez independently found that the minority who responded dramatically to gefitinib had EGFR mutations, and IPASS in 2009 proved that selecting by that mutation was what made the drug work; in 2007 Soda found the EML4-ALK fusion, and crizotinib was approved four years later. In 2012 Topalian's phase 1 showed durable responses to PD-1 blockade in lung cancer, and by 2018 chemotherapy plus pembrolizumab was standard for most patients without a driver.\n\nEarly detection followed its own track. PLCO showed in 2011 that chest radiography does nothing; NLST that year and NELSON in 2020 showed that low-dose computed tomography cuts lung cancer deaths. Eligibility is the unsolved part: pack-year thresholds exclude high-risk groups systematically, never-smokers are outside the criteria entirely, and uptake among those who qualify remains a fraction of them.\n\nSince 2017 the direction has been earlier and combined. PACIFIC put consolidation durvalumab after chemoradiotherapy in stage III disease and five-year survival reached 42.9 percent; CheckMate 816, KEYNOTE-671, AEGEAN and IMpower010 moved immunotherapy around the operation; ADAURA and ALINA did the same with targeted drugs for EGFR and ALK. Small-cell lung cancer, static since twice-daily radiotherapy in 1999, finally moved: ADRIATIC lifted median survival in limited-stage disease from 33.4 to 55.9 months, and tarlatamab, a DLL3 T-cell engager, became the first drug built for the disease. What has not moved is resistance, which arrives in one to three years for every targeted drug, and the gap between who is eligible for screening and who gets it.\n\nUK and NHS specifics (Targeted Lung Health Check coverage and uptake, NICE positions and Cancer Drugs Fund status, molecular testing turnaround, thoracic surgery and radiotherapy capacity, audit indicators and trial access) are on the UK and NHS page for lung cancer and are not restated here.","status":"active","asOf":"2026-09-25","links":[{"label":"NCI PDQ: lung cancer","url":"https://www.cancer.gov/types/lung"},{"label":"ESMO guidelines: lung and chest tumours","url":"https://www.esmo.org/guidelines/esmo-clinical-practice-guidelines-lung-and-chest-tumours"},{"label":"IASLC: International Association for the Study of Lung Cancer","url":"https://www.iaslc.org/"},{"label":"ClinicalTrials.gov NCT01888601","url":"https://clinicaltrials.gov/study/NCT01888601"}],"tags":[],"related":["prevention-roadmap","early-detection-roadmap","targeted-therapy-roadmap","immunotherapy-roadmap","radiation-roadmap","chemotherapy-roadmap","kras-roadmap","ctdna-tests","diagnostics-roadmap"],"cancers":["lung-cancer","nsclc","sclc"],"sections":["prevention","early-detection","targeted-therapy","immunotherapy","radiation","surgery","diagnostics"],"technologies":[],"targets":[],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":[],"trials":[],"people":[],"bottlenecks":["b-early-detection","b-prevention-adoption","b-resistance","b-immunotherapy-response","b-brain-delivery","b-tumor-heterogeneity","b-rare-cancers","b-global-access","b-biomarker-validation"],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"steps":[{"era":"1950 to 1965","title":"The cause is named, and cancer epidemiology is invented to name it","description":"Wynder and Graham's 684 proven cases appeared in JAMA in May 1950 and Doll and Hill's British case-control study in the BMJ in September. Both were attacked as artefacts of how cases were chosen, so Doll and Hill built a prospective cohort of British doctors in 1951 and followed it for fifty years. The method they used, exposure recorded before outcome with a measured dose-response, is the foundation of modern cancer epidemiology; the 1964 United States Surgeon General's report and everything in tobacco control since rests on it.","refs":["paper-wynder-graham-tobacco-bronchiogenic-carcinoma-jama-1950","paper-doll-hill-smoking-lung-cancer-bmj-1950","paper-doll-hill-mortality-of-doctors-smoking-bmj-1954","paper-doll-peto-50-year-doctors-bmj-2004","prevention-roadmap"],"status":"historic"},{"era":"1970 to 2006","title":"Cytotoxic chemotherapy, and the ceiling it hit","description":"Therapeutic nihilism was the default until the Non-small Cell Lung Cancer Collaborative Group pooled individual data on 9,387 patients from 52 trials in 1995 and found a 27 percent reduction in the risk of death when chemotherapy was added to supportive care. E1594 then randomised 1,207 patients between four platinum doublets and found no difference: a 19 percent response rate and a median survival of 7.9 months, whichever drugs were used. LACE later pooled 4,584 resected patients and fixed the adjuvant rule, a 5.4 percent absolute survival gain concentrated in stage II and III disease. The first crack in the ceiling was biological rather than cytotoxic: ECOG 4599 added bevacizumab in 2006 and took median survival past twelve months for the first time, at 12.3 against 10.3 months, in the non-squamous patients without brain metastases who were allowed into the trial.","refs":["paper-nsclc-collaborative-group-chemotherapy-meta-analysis-bmj-1995","paper-schiller-ecog-1594-four-chemotherapy-regimens-nejm-2002","paper-lace-adjuvant-cisplatin-pooled-analysis-jco-2008","paper-sandler-ecog-4599-bevacizumab-nsclc-nejm-2006","chemotherapy-roadmap"],"status":"historic"},{"era":"2004 to 2013","title":"EGFR, ALK, and the invention of precision oncology in solid tumours","description":"Gefitinib worked spectacularly in about one patient in ten and was close to being abandoned. In May 2004 Lynch in the NEJM and Paez in Science independently reported that the responders had activating EGFR mutations; Paez also explained the geography, finding the mutation in 15 of 58 Japanese tumours and 1 of 61 American ones. IPASS in 2009 randomised 1,217 clinically selected patients and showed the benefit lived entirely in the mutation-positive subgroup. In 2007 Soda found the EML4-ALK fusion in 5 of 75 tumours; Kwak screened 1,500 patients to enrol 82 and got a 57 percent response rate with crizotinib, a drug built for a different target. Resistance came with it: Kobayashi's single re-biopsied patient in 2005 carried T790M, and Sequist's 37 patients in 2011 showed resistance could be genetic, histological or even reversible.","refs":["paper-lynch-egfr-activating-mutations-gefitinib-nejm-2004","paper-paez-egfr-mutations-gefitinib-science-2004","paper-mok-ipass-gefitinib-pulmonary-adenocarcinoma-nejm-2009","paper-soda-eml4-alk-fusion-nature-2007","paper-kwak-crizotinib-alk-nsclc-nejm-2010","paper-kobayashi-egfr-t790m-gefitinib-resistance-nejm-2005","paper-sequist-genotypic-histological-evolution-egfr-resistance-sci-transl-med-2011","targeted-therapy-roadmap"],"status":"historic"},{"era":"2011 to 2020","title":"Low-dose computed tomography earns its place, and chest radiography loses its","description":"PLCO randomised 154,901 people to four annual chest radiographs or usual care and after 13 years found 1,213 lung cancer deaths against 1,230: no effect at all. NLST the same year and NELSON in 2020 showed that low-dose computed tomography does reduce lung cancer mortality, and the United States task force widened eligibility in 2021 from age 55 and 30 pack-years to age 50 and 20. Aldrich had already shown what a pack-year threshold does: in a southern United States cohort, 31 percent of white smokers qualified against 17 percent of Black smokers, who develop the disease at lower cumulative exposure.","refs":["paper-plco-chest-radiograph-lung-cancer-mortality-jama-2011","paper-nlst-nejm-2011","paper-nelson-nejm-2020","paper-uspstf-lung-cancer-screening-jama-2021","paper-aldrich-uspstf-screening-african-american-smokers-jama-oncol-2019","early-detection-roadmap"],"status":"historic"},{"era":"2012 to 2019","title":"Immunotherapy, and the trouble with PD-L1 as a gate","description":"Topalian's 2012 phase 1 found durable responses to PD-1 blockade in 18 percent of lung cancer patients and the first hint that PD-L1 expression predicted them. CheckMate 017 and 057 and KEYNOTE-010 established second-line nivolumab and pembrolizumab; KEYNOTE-024 moved pembrolizumab in front of chemotherapy for PD-L1-high tumours; KEYNOTE-189 and KEYNOTE-407 combined it with chemotherapy for everybody else. IMpower110 reproduced the PD-L1-high result with atezolizumab and a different assay, which is where the assay problem became unavoidable: SP142, 22C3 and SP263 do not select the same patients.","refs":["paper-topalian-anti-pd1-nejm-2012","paper-keynote-001-pembrolizumab-nsclc-nejm-2015","paper-checkmate-017-nejm-2015","paper-checkmate-057-nejm-2015","paper-keynote-024-nejm-2016","paper-keynote-189-nejm-2018","paper-keynote-407-n-engl-j-med-2018","paper-herbst-impower110-atezolizumab-pd-l1-nejm-2020","immunotherapy-roadmap"],"status":"historic"},{"era":"2017 to 2024","title":"Stage III, and treatment moving to either side of the operation","description":"PACIFIC put a year of durvalumab after chemoradiotherapy in unresectable stage III disease; the five-year update found 42.9 percent alive against 33.4 percent and a third still free of progression. Resectable disease followed: CheckMate 816 gave nivolumab before surgery, KEYNOTE-671, AEGEAN and CheckMate 77T on both sides, IMpower010 afterwards, and NADIM II showed 93 percent of patients reaching the operating theatre against 69 percent. Targeted drugs made the same move: ADAURA for EGFR, ALINA for ALK, and LAURA for EGFR-mutant stage III disease, where a hazard ratio of 0.16 replaced durvalumab consolidation that had never worked well in that genotype.","refs":["paper-pacific-nejm-2017","paper-spigel-pacific-five-year-survival-jco-2022","paper-checkmate-816-nejm-2022","paper-keynote-671-n-engl-j-med-2023","paper-heymach-aegean-perioperative-durvalumab-nejm-2023","paper-felip-impower010-adjuvant-atezolizumab-lancet-2021","paper-provencio-nadim-ii-perioperative-nivolumab-stage-iii-nejm-2023","paper-adaura-nejm-2020","paper-wu-alina-adjuvant-alectinib-nejm-2024","paper-lu-laura-osimertinib-stage-iii-nejm-2024"],"status":"current"},{"era":"2020 to 2026","title":"The driver list grows, and first-line treatment starts to be intensified","description":"ALK moved from crizotinib to alectinib (ALEX) to lorlatinib (CROWN, 78 percent progression-free at 12 months against 39). MET exon 14 got capmatinib, RET got selpercatinib, ROS1 got crizotinib then entrectinib, BRAF V600E got dabrafenib and trametinib, HER2 got trastuzumab deruxtecan and zongertinib, and KRAS G12C, undruggable for thirty years, got sotorasib and adagrasib, with CodeBreaK 200 showing a 1.1-month gain over docetaxel. In EGFR-mutant disease, FLAURA2 added chemotherapy to osimertinib and MARIPOSA beat it outright with amivantamab and lazertinib, 23.7 months against 16.6, at the cost of ten times the treatment discontinuation.","refs":["paper-peters-alex-alectinib-crizotinib-nejm-2017","paper-shaw-crown-lorlatinib-crizotinib-nejm-2020","paper-wolf-geometry-mono-1-capmatinib-nejm-2020","paper-libretto-001-selpercatinib-nsclc-nejm-2020","paper-de-langen-codebreak-200-sotorasib-docetaxel-lancet-2023","paper-planchard-flaura2-osimertinib-chemotherapy-nejm-2023","paper-cho-mariposa-amivantamab-lazertinib-nejm-2024","paper-beamion-lung-1-zongertinib-nejm-2025","kras-roadmap"],"status":"current"},{"era":"1999 to 2026","title":"Small-cell lung cancer, static for twenty-five years and then not","description":"Turrisi's twice-daily thoracic radiotherapy in 1999 raised five-year survival from 16 to 26 percent, and the Aupérin overview showed that irradiating a brain with no detectable disease in it extends life. Then nothing, for a quarter of a century. George's 110 genomes explained why: the disease is defined by losing both copies of TP53 and RB1, and a loss cannot be inhibited. Rudin's four transcription-factor subtypes gave the field something to design around, the NOTCH finding pointed at DLL3, and in 2023 tarlatamab produced a 40 percent response rate in twice-treated patients. ADRIATIC then lifted median survival in limited-stage disease from 33.4 to 55.9 months.","refs":["paper-turrisi-twice-daily-thoracic-radiotherapy-limited-sclc-nejm-1999","paper-auperin-prophylactic-cranial-irradiation-sclc-nejm-1999","paper-george-sclc-genomic-profiles-nature-2015","paper-rudin-sclc-molecular-subtypes-nat-rev-cancer-2019","paper-impower133-n-engl-j-med-2018","paper-paz-ares-caspian-durvalumab-es-sclc-lancet-2019","paper-ahn-dellphi-301-tarlatamab-sclc-nejm-2023","paper-cheng-adriatic-durvalumab-limited-stage-sclc-nejm-2024"],"status":"current"},{"era":"2017 to 2027","title":"Reading the tumour over time: heterogeneity, ctDNA and resistance-directed treatment","description":"TRACERx sequenced 327 regions from 100 resected tumours and found that drivers are almost always clonal while later alterations are heterogeneous in more than three quarters of tumours, with copy-number heterogeneity carrying a hazard ratio of 4.9 for recurrence or death. Abbosh built a per-patient phylogenetic ctDNA assay from the same tumours and identified the patients who would relapse before any scan did. Neither is yet a clinical test in lung cancer: no randomised trial has shown that acting on a positive minimal residual disease result improves survival, which is the gap the ctDNA-guided adjuvant trials are designed to close.","refs":["paper-jamal-hanjani-tracerx-evolution-nsclc-nejm-2017","paper-abbosh-phylogenetic-ctdna-lung-cancer-nature-2017","paper-sequist-genotypic-histological-evolution-egfr-resistance-sci-transl-med-2011","ctdna-tests","diagnostics-roadmap"],"status":"emerging"},{"era":"2021 to 2030","title":"Never-smoker disease and the air people breathe","description":"About one lung cancer in five worldwide occurs in someone who never smoked, and the proportion is rising as smoking falls. Sherlock-Lung's 232 whole genomes found three subtypes with no tobacco signature, the dominant one slow-growing with drivers datable to years before diagnosis. Hill and Swanton then proposed a mechanism for at least part of it: fine particulate matter does not create the EGFR mutation, which is already present in 18 percent of histologically normal lungs, but inflames the tissue enough to let it grow. That makes air quality a cancer intervention with a measurable endpoint, and makes the screening eligibility criteria, which exclude never-smokers entirely, the wrong instrument for a growing share of the disease.","refs":["paper-zhang-lung-cancer-never-smokers-nat-genet-2021","paper-hill-lung-adenocarcinoma-air-pollutants-nature-2023","paper-uspstf-lung-cancer-screening-jama-2021","prevention-roadmap","idea-prev-clean-air-never-smoker-endpoints"],"status":"emerging"},{"era":"2026 to 2032","title":"What would have to be true for lung cancer mortality to halve again","description":"Four things, none of them a new drug class. Screening reaching the people at highest risk rather than the people easiest to enrol, which means risk-model eligibility and delivery into deprived areas rather than wider pack-year thresholds. Resistance treated as a diagnosis, with a re-biopsy or a ctDNA profile choosing the next line rather than a default. Brain metastasis prevention measured as a primary endpoint rather than counted as a secondary one. And small-cell lung cancer trialled as the four diseases Rudin's subtypes describe, in a platform with shared controls, rather than as one disease with a 62 percent grade 3 toxicity rate and a two-month gain.","refs":["idea-lung-screening-eligibility-by-risk-not-pack-years","idea-lung-resistance-directed-sequencing-at-every-progression","idea-lung-brain-metastasis-prevention-as-a-primary-endpoint","idea-lung-small-cell-platform-with-shared-controls-and-subtypes","idea-lung-deprivation-gradient-treated-as-a-defect-in-delivery"],"status":"speculative"}],"watch":[{"item":"ADRIATIC: final analysis of durvalumab, and the unblinding of the durvalumab plus tremelimumab arm, in limited-stage small-cell lung cancer","expected":"Study completion 23 October 2026 (estimated, ClinicalTrials.gov NCT03703297)","source":"https://clinicaltrials.gov/study/NCT03703297","refs":["paper-cheng-adriatic-durvalumab-limited-stage-sclc-nejm-2024","adriatic"]},{"item":"IMpower010: final overall survival for adjuvant atezolizumab after chemotherapy in resected disease","expected":"Study completion 31 August 2027 (estimated, ClinicalTrials.gov NCT02486718)","source":"https://clinicaltrials.gov/study/NCT02486718","refs":["paper-felip-impower010-adjuvant-atezolizumab-lancet-2021"]},{"item":"FLAURA2: overall survival for osimertinib with chemotherapy against osimertinib alone","expected":"Study completion 30 September 2027 (estimated, ClinicalTrials.gov NCT04035486)","source":"https://clinicaltrials.gov/study/NCT04035486","refs":["paper-planchard-flaura2-osimertinib-chemotherapy-nejm-2023","flaura2"]},{"item":"LAURA: overall survival for osimertinib after chemoradiotherapy in stage III EGFR-mutated disease","expected":"Study completion 29 October 2027 (estimated, ClinicalTrials.gov NCT03521154)","source":"https://clinicaltrials.gov/study/NCT03521154","refs":["paper-lu-laura-osimertinib-stage-iii-nejm-2024","laura"]},{"item":"MARIPOSA: final overall survival for amivantamab plus lazertinib against osimertinib in first line","expected":"Study completion 16 February 2028 (estimated, ClinicalTrials.gov NCT04487080)","source":"https://clinicaltrials.gov/study/NCT04487080","refs":["paper-cho-mariposa-amivantamab-lazertinib-nejm-2024","mariposa"]},{"item":"DeLLphi-304: final analysis of tarlatamab against chemotherapy in relapsed small-cell lung cancer","expected":"Study completion 26 March 2028 (estimated, ClinicalTrials.gov NCT05740566)","source":"https://clinicaltrials.gov/study/NCT05740566","refs":["paper-tarlatamab-sclc-n-engl-j-med-2025","paper-ahn-dellphi-301-tarlatamab-sclc-nejm-2023","dellphi-304"]},{"item":"AEGEAN: final overall survival for perioperative durvalumab in resectable disease","expected":"Study completion 11 September 2028 (estimated, ClinicalTrials.gov NCT03800134)","source":"https://clinicaltrials.gov/study/NCT03800134","refs":["paper-heymach-aegean-perioperative-durvalumab-nejm-2023"]},{"item":"CROWN: final analysis of first-line lorlatinib against crizotinib, including long-term intracranial control","expected":"Study completion 31 December 2028 (estimated, ClinicalTrials.gov NCT03052608)","source":"https://clinicaltrials.gov/study/NCT03052608","refs":["paper-shaw-crown-lorlatinib-crizotinib-nejm-2020","crown"]},{"item":"ALINA: overall survival for adjuvant alectinib against chemotherapy in resected ALK-positive disease, the longest-dated of the practice-changing perioperative trials","expected":"Study completion 19 November 2031 (estimated, ClinicalTrials.gov NCT03456076)","source":"https://clinicaltrials.gov/study/NCT03456076","refs":["paper-wu-alina-adjuvant-alectinib-nejm-2024","alina"]},{"item":"TRACERx: the full evolutionary and ctDNA dataset on 814 patients, the deepest longitudinal study of lung cancer evolution","expected":"Study completion November 2035 (estimated, ClinicalTrials.gov NCT01888601)","source":"https://clinicaltrials.gov/study/NCT01888601","refs":["paper-jamal-hanjani-tracerx-evolution-nsclc-nejm-2017","paper-abbosh-phylogenetic-ctdna-lung-cancer-nature-2017"]}]},"route":"/roadmaps/lung-cancer-evidence-roadmap/","neighbours":{"roadmap":[{"id":"prevention-roadmap","kind":"roadmap","name":"Cancer prevention roadmap: tobacco control and vaccines → biomarker-guided chemoprevention → interception in carriers","route":"/roadmaps/prevention-roadmap/"},{"id":"chemotherapy-roadmap","kind":"roadmap","name":"Chemotherapy roadmap: mustard gas → curative combinations → the warhead inside smarter drugs","route":"/roadmaps/chemotherapy-roadmap/"},{"id":"ctdna-tests","kind":"roadmap","name":"ctDNA tests roadmap: from a curiosity in plasma to blood tests that decide treatment","route":"/roadmaps/ctdna-tests/"},{"id":"diagnostics-roadmap","kind":"roadmap","name":"Diagnostics roadmap: stains → gene panels → blood tests that decide treatment","route":"/roadmaps/diagnostics-roadmap/"},{"id":"early-detection-roadmap","kind":"roadmap","name":"Early detection roadmap: organ screening → blood tests for many cancers","route":"/roadmaps/early-detection-roadmap/"},{"id":"immunotherapy-roadmap","kind":"roadmap","name":"Immunotherapy roadmap: Coley's toxins → checkpoint inhibitors → engineered immunity","route":"/roadmaps/immunotherapy-roadmap/"},{"id":"kras-roadmap","kind":"roadmap","name":"KRAS roadmap: undruggable → G12C → pan-RAS","route":"/roadmaps/kras-roadmap/"},{"id":"radiation-roadmap","kind":"roadmap","name":"Radiotherapy roadmap: X-rays → shaped beams → fewer fractions, particles and FLASH","route":"/roadmaps/radiation-roadmap/"},{"id":"targeted-therapy-roadmap","kind":"roadmap","name":"Targeted therapy roadmap: imatinib → designed for resistance → the undruggable drivers fall","route":"/roadmaps/targeted-therapy-roadmap/"}],"cancer":[{"id":"lung-cancer","kind":"cancer","name":"Lung cancer (all types)","route":"/cancers/lung-cancer/"},{"id":"nsclc","kind":"cancer","name":"Non-small-cell lung cancer","route":"/cancers/nsclc/"},{"id":"sclc","kind":"cancer","name":"Small-cell lung cancer","route":"/cancers/sclc/"}],"section":[{"id":"diagnostics","kind":"section","name":"Diagnostics & Biomarkers","route":"/fronts/diagnostics/"},{"id":"early-detection","kind":"section","name":"Early Detection & Screening","route":"/fronts/early-detection/"},{"id":"immunotherapy","kind":"section","name":"Immunotherapy","route":"/fronts/immunotherapy/"},{"id":"prevention","kind":"section","name":"Prevention & Risk","route":"/fronts/prevention/"},{"id":"radiation","kind":"section","name":"Radiation Therapy","route":"/fronts/radiation/"},{"id":"surgery","kind":"section","name":"Surgery & Interventional","route":"/fronts/surgery/"},{"id":"targeted-therapy","kind":"section","name":"Targeted Therapy","route":"/fronts/targeted-therapy/"}],"bottleneck":[{"id":"b-resistance","kind":"bottleneck","name":"Acquired resistance to every therapy","route":"/bottlenecks/b-resistance/"},{"id":"b-biomarker-validation","kind":"bottleneck","name":"Biomarkers are not validated or standardised","route":"/bottlenecks/b-biomarker-validation/"},{"id":"b-global-access","kind":"bottleneck","name":"Most of the world has almost no cancer care","route":"/bottlenecks/b-global-access/"},{"id":"b-immunotherapy-response","kind":"bottleneck","name":"No one can predict who responds to immunotherapy","route":"/bottlenecks/b-immunotherapy-response/"},{"id":"b-prevention-adoption","kind":"bottleneck","name":"Prevention we already have is not deployed","route":"/bottlenecks/b-prevention-adoption/"},{"id":"b-rare-cancers","kind":"bottleneck","name":"Rare and paediatric cancers without markets","route":"/bottlenecks/b-rare-cancers/"},{"id":"b-brain-delivery","kind":"bottleneck","name":"The brain: barrier and sanctuary","route":"/bottlenecks/b-brain-delivery/"},{"id":"b-early-detection","kind":"bottleneck","name":"The hardest cancers are found late","route":"/bottlenecks/b-early-detection/"},{"id":"b-tumor-heterogeneity","kind":"bottleneck","name":"Tumour heterogeneity and clonal evolution","route":"/bottlenecks/b-tumor-heterogeneity/"}],"paper":[{"id":"paper-lynch-egfr-activating-mutations-gefitinib-nejm-2004","kind":"paper","name":"Activating mutations in the epidermal growth factor receptor underlying responsiveness of non-small-cell lung cancer to gefitinib","route":"/key-papers/paper-lynch-egfr-activating-mutations-gefitinib-nejm-2004/"},{"id":"paper-adaura-nejm-2020","kind":"paper","name":"ADAURA: three years of osimertinib after surgery for EGFR-mutated lung cancer","route":"/key-papers/paper-adaura-nejm-2020/"},{"id":"paper-felip-impower010-adjuvant-atezolizumab-lancet-2021","kind":"paper","name":"Adjuvant atezolizumab after adjuvant chemotherapy in resected stage IB-IIIA non-small-cell lung cancer (IMpower010)","route":"/key-papers/paper-felip-impower010-adjuvant-atezolizumab-lancet-2021/"},{"id":"paper-wu-alina-adjuvant-alectinib-nejm-2024","kind":"paper","name":"Alectinib in resected ALK-positive non-small-cell lung cancer","route":"/key-papers/paper-wu-alina-adjuvant-alectinib-nejm-2024/"},{"id":"paper-peters-alex-alectinib-crizotinib-nejm-2017","kind":"paper","name":"Alectinib versus crizotinib in untreated ALK-positive non-small-cell lung cancer","route":"/key-papers/paper-peters-alex-alectinib-crizotinib-nejm-2017/"},{"id":"paper-cho-mariposa-amivantamab-lazertinib-nejm-2024","kind":"paper","name":"Amivantamab plus lazertinib in previously untreated EGFR-mutated advanced NSCLC","route":"/key-papers/paper-cho-mariposa-amivantamab-lazertinib-nejm-2024/"},{"id":"paper-kwak-crizotinib-alk-nsclc-nejm-2010","kind":"paper","name":"Anaplastic lymphoma kinase inhibition in non-small-cell lung 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