Non-Small-Cell Lung Cancer (NSCLC) Treatment

Written by Alyson Powell Key, K.A. Stump-Sutliff
Medically Reviewed by Elmer Huerta, MD, MPH and Jabeen Begum, MD on March 25, 2025
12 min read

There are many treatments for your non-small-cell lung cancer (NSCLC). Like any medical condition, it's an ongoing process.

“When you hear you have lung cancer, it’s a challenging and shocking diagnosis,” says Roy Herbst, MD, Chief of Medical Oncology/Hematology at Yale Cancer Center and Smilow Cancer Hospital in New Haven, CT.  “But take a deep breath, and then get the right treatment for your tumor, at the right time."

Talk with your medical team. Your doctors can suggest options, but it’s up to you. You’ll decide how much or what kind of therapy you want. It can depend on many things, like your:

  • Lung cancer type
  • Where it is located in your lung
  • NSCLC gene changes
  • General health
  • Preferences
  • Stage (how big the tumor is and if it’s in other organs)

After surgery, your treatment plan is often personalized and based on staging by the American Joint Committee on Cancer (AJCC). It helps your doctor know how large your tumor is (T), if it’s in your lymph nodes (N), or how far it has spread (M). They may also use stages 0, and I (1) to IV (4). Lower numbers mean the cancer hasn't spread as far. 

"Personalized therapy also includes supportive care for your symptoms,” says Herbst. Your medical team cares about your whole self, not just your cancer.

Tell your doctor if you’re having any treatment side effects. Feel free to ask about changes you’ve noticed. Or ask about your nutrition, emotional changes, or lifestyle topics like stress.

Most people will get many types of NSCLC treatments. You’ll work with your medical team to put a plan together.

You might have surgery to remove the tumor from your lung. Then, you’ll likely get chemotherapy and radiation. If one treatment stops working, there’s often another one to try. Here are some key terms to help:

Chemotherapy (chemo).Medications to kill or slow cancer cell growth. Not everyone needs it, but chemo can quickly kill growing cancer cells. You may get it before (neoadjuvant) or after (adjuvant) surgery. Some common NSCLC chemotherapies include:

  • Albumin-bound paclitaxel (nab-paclitaxel, Abraxane)
  • Carboplatin
  • Cisplatin
  • Docetaxel (Taxotere)
  • Etoposide (VP-16)
  • Gemcitabine (Gemzar)
  • Paclitaxel (Taxol)
  • Pemetrexed (Alimta)
  • Vinorelbine (Navelbine)

Your doctor may combine two or use chemo with other treatments. You may also get it with radiation --- chemoradiation.

Immunotherapy. Your body uses “checkpoint” proteins to avoid attacking itself. Cancer cells also use them to bypass the attack. But immunotherapies turn off the tumor's checkpoint proteins called PD-1 and PD-L1.

Atezolizumab (Tecentriq) and durvalumab (Imfinzi) target PD-L1 protein. Cemiplimab (Libtayo), nivolumab (Opdivo), and pembrolizumab (Keytruda) target the PD-1 protein. These therapies shrink or slow your tumor growth.

Radiation. Radiation kills cancers cells with high-energy rays (X-rays). There are three different radiation therapies: external beam radiation (EBRT), brachytherapy, and proton therapy.

External beam radiation treatment (EBRT) is the most common. A large machine focuses precise radiation doses into your tumor through your skin. 

There isn’t any pain. It only lasts a few minutes, five days each week for 5 to 7 weeks.

If it's early stage and surgery isn’t an option, you may get stereotactic body radiation therapy (SBRT). It’s also used to treat tumors in other body parts, like your brain. 

SBRT uses higher radiation doses. So you'll only need one to five treatments. Other EBRT methods use computers to measure exactly where the radiation beam goes.

Internal radiation (brachytherapy) can shrink your tumor to help your NSCLC symptoms. Doctors put tiny radioactive pellets near or directly into your tumor. These pellets keep the radiation nearby, so it can’t hurt healthy tissues.

A third option may be proton therapy forlater-stage NSCLC. It uses positively charged radiation beams (protons). The beams may not hurt nearby organs, but are still being studied.

Surgery. Surgery takes out your lung tumor, giving you the best chance for a cure. It's an option if you have a small tumor, early-stage NSCLC. Your surgery can depend on where and how much cancer there is. 

Your surgeon may suggest a lobectomy to remove the tumor in a lobe of your lung. Your lungs have lobes — three on the right and two on your left. 

You may get a pneumonectomy to take out your entire lung,if your tumor is near the center of your chest.

Your surgeon may do a segmentectomy to remove part of your lobe, also called a wedge resection.

A sleeve resection takes out the cancer in your airways and usually a lobe of your lung. They'll reconnect your airway after removing the portion (sleeve) with cancer. If there's cancer in nearby lymph nodes, they'll take them out, too.

Targeted therapy. There are about 10 types of targeted therapies. Antibodies act on specific proteins and gene changes in your cancer cells. Your doctor may test your tumor for gene changes. You can get targeted therapy alone, in combination, or with chemo. You’ll help decide what’s best.

NSCLC tumors can make extra protein to grow and spread. These include ALK, BRAF, EGFR, KRAS, MET, RET, ROS1, TRK, or VEGF. Targeted therapies stop your tumor from using them to slow growth.

ALK inhibitors for NSCLC include: 

  • Alectinib (Alecensa)
  • Brigatinib (Alunbrig)
  • Ceritinib (Zykadia)
  • Ensartinib (Ensacove)
  • Lorlatinib (Lorbrena)

Alectinib (Alecensa) is an ALK inhibitor taken for an early-stage tumor, after it’s removed.

BRAF inhibitors are usually given with MEK inhibitor (another targeted therapy):

  • Dabrafenib (Tafinlar) with trametinib (Mekinist)
  • Encorafenib (Braftovi) with binimetinib (Mektovi)

Epidermal growth factor receptor (EGFR) inhibitors include: 

  • Afatinib (Gilotrif)
  • Amivantamab (Rybrevant)
  • Dacomitinib (Vizimpro)
  • Erlotinib (Tarceva)
  • Gefitinib (Iressa)
  • Lazertinib (Lazcluze)
  • Osimertinib (Tagresso) 

You'll get these alone, together, with chemo, or another targeted therapy.

HER-2 medication like fam-trastuzumab deruxtecan-nxki (Enhertu) is an antibody-drug conjugate. It combines an antibody and a chemo medicine. Sometimes, ado-trastuzumab emtansine (Kadcyla) and zenocutuzumab-zbco (Bizengri) are also used.

KRAS inhibitors like adagrasib (Krazati) and sotorasib (Lumakras) help slow down tumor growth in your body, too.

MET therapies include capmatinib (Tabrecta) or tepotinib (Tepmetko).

RET inhibitors are given alone or with other medicines:

  • Cabozantinib (Cometriq, Cabometyx), which acts against MET, RET, ROS1, and VEGF proteins
  • Pralsetinib (Gayreto)
  • Selpercatinib (Retevmo)

ROS1 inhibitors can help slow your tumor growth, including:

  • Ceritinib (Zykadia)
  • Crizotinib (Xalkori)
  • Entrectinib (Rozlytrek)
  • Lorlatinib (Lorbrena)

TRK inhibitors like larotrectinib (Vitrakyi) or entrectinib (Rozlytrek) may be used first.

Vascular endothelial growth factor (VEGF) inhibitors stop your tumor from forming blood vessels. Therapies such as bevacizumab (Avastin) and ramucirumab (Cyramza) may be combined with other treatments, too.

Clinical trials. NSCLC can be a challenge to treat. Clinical trials may offer you the best and newest treatments available. Talk to your doctor if you’d like to learn more about them. They’ll help you decide if you may qualify, and what’s involved.

“The clinical trials of today will be approved [medicines] in three or four years,” says Herbst. “Even though some of these [medicines] aren’t proven, there’s a chance to upgrade your therapy. Most centers have clinical trials, and we are very actively recruiting to them.”

Occult lung cancer means the cancer cells are in the mucus from your lungs (sputum) or in your airway fluid. It’s also called "hidden" because imaging scans can’t see it yet. It’s often just on the surface of your lungs.

This type of lung cancer may first appear like other health problems. Although your doctor won’t find a solid tumor, they’ll do a bronchoscopy. It uses a camera to look for cancer cells.

They’ll also take a sample of your lung mucus for cytology, checks for abnormal cells under a microscope. And your doctor may repeat tests and check you every few months.

This stage is called carcinoma in situ. You may have abnormal cells in your airway lining. These cells can turn into cancer or spread to nearby healthy tissue. Since stage 0 NSCLC stays in the airway lining, it usually doesn’t get into deeper lung tissue.

You’ll likely get surgery to remove the tumor from you lung lobe (lobectomy). But you probably won't get chemotherapy or radiation.

Sometimes, you'll get endobronchial therapy like cryotherapy or photodynamic therapy. These use special medicines and light to preserve lung health. You may also get laser therapy or brachytherapy (internal radiation), depending on what you decide.

Stage 1 includes many substages (IA1, IA2, IA3, and IB) depending on the size of your tumor, where it grows, and how it's treated.

Stage 1A treatment. You’ll likely get surgery to remove your tumor and that part of your lung. If you’re having breathing problems, you may get a segmental or wedge resection. Otherwise, you’ll likely get a lobectomy or sleeve resection.

They'll also take out nearby lymph nodes to check for cancer. If testing shows all cancer was removed, this may be the only treatment you'll need. 

There's mixed evidence about chemotherapy or radiation after the removal of your stage 1A tumor. You may get chemo as part of a clinical trial, though.

Stage 1B treatment. Getting additional treatment at this stage is still controversial. It’s usually just surgery to remove your tumor. You may need chemo if your tumor has higher risk features like:

  • A size of 4 centimeters (cm)
  • Involvement of your lymph nodes
  • Not being a specialized cell type (poor differentiation)
  • A higher growth rate

Your doctor may also look at special molecular markers in your cancer cells. These can tell you if you're at a higher risk of the cancer returning. If so, chemotherapy, immunotherapy, or targeted therapy may help lower your chance of it coming back.

If surgery isn’t an option, you can try radiation therapy. You may get SBRT for 1-2 weeks. Or clinical trials may be a good option. Talk to your doctor to see if you’re a good fit.

Surgery is the most common stage 2 non-small-cell lung cancer treatment. They'll remove your tumor and take out any lymph nodes with cancer. Your surgery depends your tumor size and location. You may get a:

  • Lobectomy if it's in a lobe.
  • Pneumonectomy to take out your entire lung near the center of your chest.
  • Segmental or wedge resection to remove part of your lobe.
  • Sleeve resection to remove the lobe and cancer in your airway.

You'll get chemoradiation to shrink the tumor before surgery at the very top of your lungs (superior sulcus). You may get more chemo after surgery, too.

Stage 2A and 2B treatment. Surgery helps stage 2A and 2B non-small-cell lung cancer. You'll probably get cisplatin-based chemotherapy next. You can also get immunotherapies like atezolizumab (Tecentriq) or pembrolizumab (Keytruda). 

If your tumor cells make too much of certain proteins, you may get targeted therapy. When surgery isn’t an option, you may also get radiation. Radiation and chemo may also help lower your risk of the cancer coming back.

There are many ways to combine treatments. If you have more advanced cancer, you can find NCI-supported clinical trials. Talk with your doctor, they’ll help you decide on the best treatment plan.

Stage 3 non-small-cell lung cancer is a complex mix of tumor types. It may be in your lymph nodes or your tumor is larger --- treating it can be a challenge.

Only a few tumors can be removed by surgery. And you'll likely get a mix of chemo, radiation, or other therapies before and after surgery, too. Surgery is possible if your:

  • Tumor is smaller than 5 cm and isn’t at the top of your lung.
  • Tumor hasn’t grown between the spaces in your lungs.
  • Tumor is larger than 7 cm across but hasn't spread to your lymph nodes.

Your surgeon will check and remove any lymph nodes with cancer. You'll discuss what's best if you have a tumor in both lungs (bigger than 5 cm), at the top, or between the spaces of your lungs.

Often, you’ll start neoadjuvant therapy. It's chemoradiation or chemo with immunotherapy to shrink your tumor before surgery.

After your surgery, you’ll probably get cisplatin-based chemotherapy. But if your tumor has certain gene changes, you'll get another targeted treatment. Talk to your doctor about what’s best for your health.

If surgery isn’t an option, you may decide on chemoradiation. Your doctor may also suggest immunotherapy with durvalumab for up to one year.

Mediastinal nodes are the lymph nodes in the space between your lungs (mediastinum). The mediastinum is the central part of your chest that holds your organs. If the cancer is in these lymph nodes, it’s usually stage 3B. At this stage, the tumors are usually less than 7 cm in size and in one lung.

Chemoradiation as treatment. If your tumor isn’t removed, you may get chemoradiation. Most stage 3 tumors aren't removed — either by choice or other health reasons. You'll likely get chemoradiation, though.

And you’ll probably get durvalumab (Imfinzi), animmunotherapy for up to one year. But if your tumor has another gene variant, you’ll get something else.

If these treatments aren’t possible, radiation is an option to control symptoms. It’s often combined with palliative care, too.

Superior sulcus tumors are at the very top of your lungs. Nearby structures in your body, like your spinal cord, can make them harder to treat. Doctors often treat them based on size.

Chemoradiation can shrink tumors less than 7 cm across before surgery. A chest CT scan can check to see if the tumor is small enough to take out. After surgery, you'll get more chemo. 

But if your tumor is bigger than 7 cm across, treatment depends on whether it can be removed. If not, you may opt for radiation dose escalation combined with chemo. You may also get immunotherapy like durvalumab for up to one year.

Clinical trials may also be an option; talk to your doctor about what’s best for your health.

The cancer has likely spread to both your lungs at this stage. The fluid around your lung and heart may also be involved. Your cancer may be in a distant lymph node or another organ.

Stage 4 can also mean your cancer has come back (relapsed). Although rarely cured, treatment can help keep stage 4 NSCLC under control.

Whole-body (systemic) treatments. In most cases, targeted therapy, chemotherapy, and immunotherapy are the main treatments. A lab will test your cancer cells for gene changes in your cancer cells. You and your doctor can decide which treatment will work best.

Over time, targeted therapy may stop working. If this happens, you'll start another one. Your doctor may call this “subsequent therapy”. There are many NSCLC treatments to try. Your doctor can also combine chemo, radiation, targeted, or immunotherapies, too.

Local treatments. Treatment just around the area where your tumor is at ---- also called “local” treatment. You can often add chemo, targeted therapy, or immunotherapy.

SBRT radiation therapy. Special high-dose radiation can shrink your tumor (like a small brain tumor).  Doctors may also use radiation to treat your symptoms like pain, bleeding, or breathing problems.

Pericardiocentesis.Surgeons can drain the fluid around your heart if you have cancer cells in it. They'll create a small hole (pericardial window) in the sac around your heart. It drains the excess fluid out into your chest to help your heart work better.

Thoracentesis.If you have cancer cells in the fluid around your lung, your doctor can remove it. They'll use a needle or a soft, thin tube (catheter) to drain the fluid from the small space holding it.

The survival rate for NSCLC depends on many different things, including your:

  • Cancer stage
  • Non-small-cell lung cancer subtype
  • Other health conditions

About 65 in 100 people with early-stage NSCLC are still alive five years after diagnosis. However, overall survival for non-small-cell lung cancer is about 15 in 100 people after five years. Early diagnosis and treatment are key.

But keep in mind these numbers can’t tell you how long you’ll live. Or how your body will react to treatment. To understand what these numbers mean for you, talk to your doctor.

Your non-small-cell lung cancer treatment depends on your tumor stage, gene testing, and overall health. If you’re diagnosed early, surgery may be all you need. But there are always other treatments like radiation, chemotherapy, immunotherapy, or targeted therpies. Talk to your doctor about your best NSCLC treatment plan.

How treatable is non-small-cell lung cancer?

Non-small-cell lung cancer is treatable, especially when diagnosed early. Options include surgery, radiation, chemotherapy, targeted therapy, and immunotherapy. If you’re diagnosed at a later stage, you may get chemoradiation. You'll also get supportive care to manage symptoms and improve your quality of life.

Is non-small-cell lung cancer curable?

NSCLC may be curable if it’s detected early and completely removed by surgery. But factors such as the type of cancer, its stage, and your overall health also play a role.

Is nivolumab used in non-small-cell lung cancer treatment?

Nivolumab is a PD-1 inhibitor used to treat non-small-cell lung cancer. It’s used as an adjuvant (add-on) treatment. It helps your immune system attack the cancer.

How aggressive is adenocarcinoma lung cancer?

Lung adenocarcinoma is aggressive, growing quickly. If doctors find it before it spreads, about 60 in 100 people live at least five years.