US-China Treatment Comparison: The Evolution of Standard Therapies for Non-Small Cell Lung Cancer Over the Past Decade

DengyueMed understands that non-small cell lung cancer (NSCLC) accounts for 80%-85% of all lung cancers and is one of the leading causes of cancer-related deaths worldwide. Over the past decade, its standard therapies have undergone a revolutionary shift from "primarily radiotherapy and chemotherapy" to "precision therapy + immunotherapy," with treatment concepts evolving from "one-size-fits-all" group therapy to "tailor-made" individualized treatment.

Ten years ago, platinum-based chemotherapy was the core treatment regimen for advanced NSCLC. While it could briefly extend survival, the side effects were significant, and efficacy had reached a bottleneck. At that time, the treatment for early-stage NSCLC primarily involved surgical resection, with postoperative adjuvant chemotherapy as the main consolidation method, but benefits were limited for patients with positive lymph nodes. The core goal of treatment in this phase was "controlling tumor progression," with relatively less consideration for patients' quality of life.

With the development of molecular biology techniques, targeted therapy gradually took center stage, becoming the first key turning point in the evolution of therapies over the decade. The discovery of driver genes such as epidermal growth factor receptor (EGFR) and anaplastic lymphoma kinase (ALK) enabled the application of targeted tyrosine kinase inhibitors (TKIs). For example, the emergence of EGFR-TKIs like osimertinib significantly extended survival for patients with EGFR-sensitive mutations, with side effects far less than traditional chemotherapy, quickly replacing chemotherapy as the first-line standard treatment for such patients.

In the past five years, the rise of immunotherapy has further reshaped the treatment landscape for NSCLC. Immunotherapies represented by PD-1/PD-L1 inhibitors activate the patient's own immune system to attack tumors, achieving long-term survival for some patients. From second-line treatment for advanced patients to first-line monotherapy or combination therapy, and then to consolidation therapy after chemoradiotherapy for locally advanced patients, the application scenarios for immunotherapy have continuously expanded, becoming an important treatment option for NSCLC patients without driver gene mutations. At the same time, perioperative treatment for early-stage NSCLC has seen breakthroughs, with neoadjuvant immunotherapy or targeted therapy combined with surgery significantly improving patients' pathological remission rates and disease-free survival.

Development and Evolution of Diagnosis and Treatment for Non-Small Cell Lung Cancer

As the core hubs for global lung cancer diagnosis and treatment research, China and the United States have both achieved significant accomplishments in the development of NSCLC diagnosis and treatment. However, due to differences in population characteristics, medical resources, and drug accessibility, they have formed distinct development paths.

In terms of diagnostic and treatment concepts, both countries highly endorse the core values of evidence-based medicine and multidisciplinary collaboration (MDT). The United States, with its leading clinical research system, holds a first-mover advantage in basic research and clinical trial execution for targeted therapy and immunotherapy. Many blockbuster drugs' global multicenter clinical trials are led by the US, driving the establishment of global NSCLC diagnostic and treatment standards. China, leveraging its vast patient population, has rapidly conducted localized clinical trials, focusing on driver gene mutations prevalent in the Chinese population and unique risk factors, achieving "localized adaptation" of diagnostic and treatment regimens.

In terms of the universal of treatment technologies, medical resources in the United States are relatively evenly distributed, with universal high rates for early screening and precision therapy. In particular, the widespread use of low-dose spiral CT (LDCT) screening has led to the detection of more early-stage NSCLC cases, laying the foundation for curative treatment. In recent years, China has also vigorously promoted lung cancer early screening and diagnosis programs, but due to its vast territory and uneven distribution of medical resources, some grassroots areas still rely mainly on traditional radiotherapy and chemotherapy, and the universal of precision therapy needs further improvement.

In drug development and application, the US FDA has approved more types of NSCLC treatment drugs, especially targeted drugs for rare driver genes and novel immunotherapies, with listing speeds leading the world. China, through reforms in its drug review and approval system, has accelerated the market entry of innovative drugs. At the same time, the rise of domestically developed targeted drugs and immunotherapies has significantly improved drug accessibility and reduced treatment costs for patients. For example, drugs like sunvozertinib for EGFR exon 20 insertion mutations and domestic drugs for KRAS G12C mutations have been approved for marketing in China, providing more treatment options for Chinese patients.

Milestone Events in Standard Therapies Over the Past Decade (China and US)

Over the past decade, numerous milestone events have emerged in the field of NSCLC standard therapies in China and the United States, driving continuous innovation in the treatment landscape. Key events are as follows:

• 2015-2016: The US FDA approved osimertinib for second-line treatment of NSCLC patients with EGFR T790M mutations, and China approved the indication in 2017, marking the entry of EGFR-TKI therapy into the era of "precision resistance management"; The US NCCN guidelines first recommended the PD-1 inhibitor nivolumab for second-line treatment of advanced NSCLC, opening the prelude to the clinical application of immunotherapy.

• 2018-2019: The US FDA approved pembrolizumab for first-line monotherapy in PD-L1-positive advanced NSCLC, establishing the first-line status of immunotherapy in patients without driver gene mutations; China's NMPA approved durvalumab for consolidation therapy after concurrent chemoradiotherapy in unresectable stage III NSCLC, filling the gap in consolidation treatment for locally advanced NSCLC.

• 2020-2022: The US FDA approved multiple targeted drugs for rare driver genes, such as ensartinib for ALK rearrangements and capmatinib for MET amplifications; China's CSCO guidelines first included domestic PD-1 inhibitors in first-line treatment recommendations for advanced NSCLC, and approved osimertinib for postoperative adjuvant therapy in early-stage EGFR mutation patients, extending targeted therapy from advanced to early stages.

• 2023-2025: The US FDA approved cMet ADC drug Telisotuzumab vedotin-tllv and NRG1 fusion inhibitor Zenocutuzumab, further refining treatment paths for rare targets; China's NMPA approved sunvozertinib for second-line treatment of EGFR exon 20 insertion mutation NSCLC, and durvalumab's new indications were approved, expanding the applicable population to stage III NSCLC patients after sequential chemoradiotherapy. The US FDA also synchronously updated relevant indication recommendations.

Overall, the milestone events in China and the US over this decade exhibit characteristics of "the US leading frontier exploration, with China quickly following and innovating locally," while also driving the continuous iteration of global NSCLC diagnostic and treatment standards, deeply ingraining the concepts of precision therapy and immunotherapy, and bringing sustained survival benefits to patients.

Comparison of Current Optimal Treatments in China-US Guidelines

Currently, China's "Clinical Guidelines for Lung Cancer Diagnosis and Treatment (2025 Edition)" (CSCO Guidelines) and the US "NCCN NSCLC Clinical Practice Guidelines (2025.V7 Edition)" are the core reference bases for NSCLC diagnosis and treatment in the two countries. They share consensus on optimal treatment recommendations but also show significant differences due to national conditions.

In terms of core consensus, both guidelines regard early screening as key to reducing lung cancer mortality, recommending LDCT for high-risk populations; both emphasize genetic testing as a prerequisite for precision therapy, prioritizing detection of common driver genes such as EGFR, ALK, and ROS1; for early operable NSCLC, both recommend surgical resection combined with systematic lymph node dissection, with postoperative adjuvant therapy formulated based on pathological staging and genetic status; for unresectable stage III NSCLC, both recommend concurrent chemoradiotherapy followed by durvalumab consolidation therapy (for patients without driver gene mutations).

Differences mainly manifest in the following dimensions: First, in screening population definitions, China's guidelines pay more attention to "Chinese characteristics" risk factors, recommending starting from age 45 and including long-term exposure to secondhand smoke, kitchen fumes, family history of lung cancer, etc., as high-risk factors; US guidelines focus on smoking history as the core hard indicator, recommending starting age of 50 and above, with less emphasis on environmental factors. Second, in drug recommendation priorities, China's guidelines prioritize domestically approved and highly accessible drugs, especially domestic innovative drugs, such as recommending domestic drugs for post-line treatment of KRAS G12C mutations and omitting sotorasib, which is not yet widely used in China; US guidelines, based on global evidence-based evidence, recommend more international cutting-edge drugs, some of which may not yet be available in China. Third, in refining treatment populations, China's guidelines are more specific for postoperative adjuvant therapy in stage IB EGFR mutation and ALK mutation patients, designating osimertinib and alectinib as level I recommendations; although US guidelines also recommend such drugs, the population scope is relatively broader. Fourth, in follow-up strategies, China's guidelines provide refined stratification of follow-up intervals and examination items for patients at different stages, such as enhanced chest and abdominal CT every 8-12 weeks for early and mid-stage postoperative patients, and adding brain MRI, whole-body bone scans, etc., for advanced patients based on metastatic sites; US guidelines, focusing more on early-stage NSCLC, mention fewer details on follow-up for advanced patients.

Future Trend Predictions and Summary

Looking ahead, the diagnosis and treatment of NSCLC will continue to develop toward "more precise, more efficient, and more individualized" directions, while the diagnostic and treatment practices of China and the US will increasingly integrate through exchange and collaboration.

In terms of treatment technologies, targeted therapy will further advance toward "full target coverage," with more drugs emerging for rare driver genes, such as breakthroughs in inhibitors for targets like FGFR and NTRK; optimization of immunotherapy will become a focus, including exploration of novel immunotherapies like bispecific antibodies and CAR-T cell therapy, as well as precision of immune combination regimens (e.g., combined with anti-angiogenic drugs, personalized vaccines, etc.); additionally, antibody-drug conjugates (ADCs) as novel targeted therapies will demonstrate value in more targets and treatment stages, becoming an important supplement to precision therapy.

In terms of diagnostic and treatment models, multidisciplinary collaboration will become more in-depth and routine, leveraging artificial intelligence for precise analysis of tumor imaging, pathological sections, and genetic data to assist clinical decision-making; the universal rate of early screening will further increase, especially in China, where grassroots medical resource construction will be strengthened to promote full coverage of LDCT screening in high-risk populations, achieving the goals of "early detection, early diagnosis, early treatment"; meanwhile, optimization of diagnostic and treatment regimens based on big data and real-world studies will become a trend, providing evidence more aligned with clinical practice for individualized treatment.

In terms of China-US collaboration, as China's clinical research level continues to improve, more localized research outcomes will be incorporated into the global evidence-based medicine system, promoting the refinement of global NSCLC diagnostic and treatment standards; at the same time, cooperation between China and the US in drug development, technology promotion, patient management, and other areas will become closer, facilitating rapid cross-border approval and clinical application of innovative drugs, allowing global patients to share the fruits of medical progress.

Summary and Outlook

Over the past decade, the diagnosis and treatment of non-small cell lung cancer has achieved leapfrog development, from the "survival gamble" of traditional radiotherapy and chemotherapy to the "efficacy leap" of precision therapy and immunotherapy, significantly improving patients' survival and quality of life. Both China and the US have played key roles in this process, with the US leading global diagnostic and treatment directions through cutting-edge research, and China achieving precise adaptation of diagnostic and treatment regimens through localized innovation. Their differences stem from national conditions and population characteristics, but the core goal is to provide patients with higher-quality diagnostic and treatment services.

In the future, with continuous breakthroughs in medical technology and deepening global medical collaboration, the treatment of non-small cell lung cancer will usher in more new possibilities. We have reason to believe that through ongoing basic research, clinical trials, and optimization of clinical practices, non-small cell lung cancer will gradually transform from a "fatal cancer" to a "manageable chronic disease," and even achieve clinical cure for some patients. At the same time, China and the US will continue to exchange and collaborate in diagnostic and treatment concepts, technological innovation, drug development, and other fields, contributing more to the global cause of lung cancer prevention and control, ultimately benefiting every lung cancer patient.