Questions to Ask About Lung Cancer Treatment

Two things have to be settled before any plan means anything.

The first is the type. Non-small cell lung cancer and small cell lung cancer are treated on different tracks. Most of what follows applies to non-small cell disease.

The second is whether surgery is on the table. NCI calls surgery the treatment of choice for stage I and stage II non-small cell lung cancer, and says resectable disease carries the best prognosis. Whether it applies depends on stage, on where the tumor sits, and on your lung function.

Ask these two first:

• What is the exact cell type on my pathology report?
• Is my cancer resectable, and if not, what makes it unresectable?

For non-small cell lung cancer, especially adenocarcinoma, gene testing changes the drugs available. The alterations with approved therapies or drugs in development include EGFR, ALK, ROS1, KRAS, and others.

Some numbers give a sense of how common they are:

• EGFR exon 19 deletions and L858R appeared in 52% of tumors from people who never smoked. They appeared in 15% from former smokers and 6% from current smokers.
• ALK fusions occur in 3% to 7% of unselected non-small cell lung cancers.
• ROS1 fusions occur in up to 2%.
• NTRK fusions occur in up to 1%, and can be treated with larotrectinib or entrectinib.

Ask directly whether full molecular testing has been done, and whether the results are back. Our page on biomarker testing covers how the panels work.

Three approaches now surround an operation, and each rests on a specific trial.

Chemotherapy plus immunotherapy before surgery. CheckMate 816 enrolled 358 people with resectable stage IB to IIIA disease. Adding nivolumab by vein to platinum-doublet chemotherapy before surgery raised median event-free survival from 20.8 months to 31.6 months. How many cycles you would have, and whether you are a candidate at all, is set by your own team.

Immunotherapy before and after surgery. KEYNOTE-671 enrolled 797 people with untreated stage II, IIIA, or IIIB disease. Pembrolizumab by vein was given alongside cisplatin-based chemotherapy before surgery and then continued afterwards for roughly a year in total. Median event-free survival was 47.2 months with pembrolizumab and 18.3 months with placebo.

Targeted therapy after surgery, if you have the right mutation. Two trials matter here:

• ADAURA enrolled 682 people with removed stage IB to IIIA disease and an EGFR exon 19 deletion or L858R variant. Osimertinib, one tablet by mouth daily for up to 3 years, produced a 5-year survival rate of 88%, against 78% on placebo.
• ALINA enrolled 257 people with completely removed ALK-positive disease. Alectinib, taken by mouth twice daily for up to two years, produced a 2-year disease-free survival rate of 93.8% in stage II and IIIA disease, against 63.0% for chemotherapy. FDA has approved alectinib in this setting. Both of these are tablets you take at home, and both get reduced when side effects demand it. Take the strength and schedule written on your own prescription, not any figure from a trial report, and ask before changing it.

Worth asking:

• Will I get treatment before surgery, after it, or both?
• If I have an EGFR or ALK change, does that change what I get after surgery?
• How long would I be on a daily pill, and what does stopping look like?

For stage III disease that cannot be removed, the standard path is chemoradiation followed by a year of immunotherapy.

The PACIFIC trial enrolled 713 people with stage III disease whose cancer had not progressed after at least two cycles of platinum-based chemoradiation. They received durvalumab by vein for up to a year, or placebo; the strength and interval are set by the prescribing team. Median progression-free survival was 16.9 months with durvalumab and 5.6 months with placebo. Median overall survival was 47.5 months.

Worth asking:

• Am I a candidate for durvalumab after chemoradiation, and when would it start?
• What scan confirms my disease has not progressed before that begins?

For metastatic disease, the molecular result usually decides the first treatment rather than chemotherapy defaults. Named options include:

• EGFR inhibitors, with or without chemotherapy, for EGFR variants.
• Separate EGFR-directed therapy for exon 20 insertions, which behave differently.
• ALK inhibitors for ALK translocations.
• ROS1 inhibitors for ROS1 rearrangements, including crizotinib and entrectinib.
• KRAS G12C inhibitors for that specific variant.

NCI notes that MET amplification has been linked to later resistance to EGFR inhibitors. That is worth knowing in advance, because it explains why a repeat biopsy may be suggested if a targeted drug stops working.

Worth asking:

• Which drug matches my specific alteration?
• If this drug stops working, will you biopsy again to find out why?
• Does my treatment reach the brain if the cancer goes there?

About brain imaging. Prophylactic cranial irradiation may lower the rate of brain metastases, but NCI notes there is no evidence of a survival benefit and its effect on quality of life is unknown. Ask what brain imaging schedule you are on instead, and what would trigger a scan.

About breathing. Lung function shapes what treatment you can tolerate, not just whether you can have surgery. Ask what your pulmonary function tests showed and how they factor into the plan.

Bring a written list, and ask the team to name the goal of treatment out loud: cure, long-term control, or symptom relief. Those three lead to different tradeoffs, and they are not always stated unless asked.

Ask which decision has a deadline this week and which can wait for a pending result. A pathology or molecular result that is still outstanding can change the entire drug choice, so it is fair to ask whether starting now would close off an option later.

For the disease overview and the full menu of treatment types, see lung cancer and cancer treatment overview. If a trial is on the table, clinical trial versus standard treatment explains the tradeoff.

• National Cancer Institute, Non-Small Cell Lung Cancer Treatment PDQ, health professional version, updated May 15, 2025; accessed August 6, 2026