Chong Kin Liam

"Background Lung cancer is the leading cause of cancer-related mortality in the Asia Pacific (APAC) region, accounting for approximately 60% of global cases. The demographic of lung cancer in this region is shifting, with increasing incidence among younger individuals, non-smokers, and women. Driven by diverse risk factors including air pollution, occupational hazards, genetic predisposition, and household cooking fumes, there is a pressing need for personalized approaches to screening, diagnosis, and treatment. Early Detection & Screening Low-dose computed tomography (LDCT) screening has been instrumental in shifting detection toward early-stage disease. While global trials primarily focus on heavy smokers, regional data indicates that genetic factors play a critical role. A nationwide screening program in Taiwan demonstrated that individuals with a family history of lung cancer have a higher detection rate of early-stage disease (89.6%) compared to heavy smokers (66.1%). This targeted screening approach has led to a significant stage shift and a projected 53% reduction in lung cancer mortality. Targeted Therapy & Immunotherapy Recent phase III trials evaluating targeted therapies (such as osimertinib, amivantamab plus lazertinib, and lorlatinib) and immunotherapies (including pembrolizumab and neoadjuvant nivolumab) show that clinical efficacy and toxicity profiles in Asian cohorts are highly consistent with global populations. Subgroup analyses from landmark trials, including FLAURA2, MARIPOSA, KEYNOTE-189, and CheckMate 816, confirm that APAC patients derive comparable progression-free survival (PFS), overall survival (OS), and pathological complete response (pCR) benefits from these advanced treatment modalities. Conclusions & Future Challenges Despite the biological efficacy of advanced treatments mirroring global outcomes, the APAC region faces unique, systemic challenges. Wide regional variations in healthcare infrastructure, drug pricing, and reimbursement criteria—along with underrepresentation in global clinical trials—create significant disparities in early diagnosis and treatment access. Overcoming these socio-economic barriers and optimizing management strategies in resource-limited settings remain the primary challenges for improving lung cancer survival rates across the Asia Pacific region. "

Lung Cancer Screening: Hurdles in Asia-Pacific Region Noni Novisari Soeroso Department of Pulmonology and Respiratory Medicine, Faculty of Medicine Universitas Sumatera Utara, Medan, Indonesia Abstract Lung cancer is the leading cause of cancer-related death worldwide, and Asia carries a disproportionate share of the burden: over 60% of new cases and deaths occur there, and the Western Pacific Region alone accounts for nearly half of global cases. Although low-dose computed tomography (LDCT) has been shown to reduce lung cancer mortality, only 22% of countries in the Western Pacific have implemented screening programs. This review summarizes the main barriers to implementation across the Asia-Pacific region. First, high costs and limited reimbursement, especially in low- and middle-income countries. Second, inadequate infrastructure, including too few CT scanners and shortages of trained radiologists and thoracic specialists. Third, low public awareness and cultural barriers such as fear, stigma, and fatalism. A distinctive regional challenge is the high proportion of lung cancer in never-smokers, particularly Asian women, which makes Western smoking-based screening guidelines a poor fit. In addition, endemic tuberculosis increases false-positive LDCT findings, and no validated risk-prediction models exist for non-smoking Asian populations. Healthcare financing disparities, fragmented cancer registries, and vulnerability to climate-related disruptions further complicate implementation in low-resource settings. Addressing these barriers will require regionally adapted screening criteria that include non-smoking risk factors, investment in infrastructure and workforce training, integration of screening with tuberculosis and smoking-cessation programs, and sustained policy advocacy to secure government funding. Overcoming them is essential to reducing the large and growing burden of lung cancer across Asia-Pacific. Keywords: Lung cancer screening - Asia-Pacific - low-dose computed tomography - health equity - never-smokers - implementation barriers