New Challenges of Lung Cancer Management in the Asian Pacific Region

"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. "