UChicago Medicine Thoracic Surgery Chief Highlights Precision and Personalized Approaches in Lung Cancer Care, Pursues Innovative Therapies for Advanced Disease

Author: Joanna

As the leading cause of cancer-related incidence and mortality worldwide, lung cancer’s prevention and control depend not only on technological innovation but also on the overall maturity of the diagnosis and treatment system. Given the complexity of the disease and significant individual variability, a single therapeutic approach can no longer meet clinical needs. Recently, Dr. Jessica Donington, Chief of Thoracic Surgery at the University of Chicago Medicine, pointed out that lung cancer diagnosis and treatment pathways are becoming increasingly diversified and technologically advanced globally. Particularly in early diagnosis and minimally invasive interventions, a new paradigm of multi-technology synergy has emerged.

At the level of treatment implementation, minimally invasive surgery, surgical robots, targeted therapy, and immunotherapy are working in synergy to gradually realize the concept of “tailor-made” personalized intervention. Surgical resection has become increasingly minimally invasive with significantly improved precision; targeted drugs and antibody-drug conjugates (ADCs) offer the possibility of directed attacks for patients with distinct molecular profiles; and the collaborative model of multidisciplinary teams (MDTs) has become the core driving force in formulating combination treatment strategies.

It is worth noting that systemic support serves as the foundation for implementing high-quality prevention and treatment pathways. The coverage and follow-up management of national early screening programs, the continuous improvement of diagnostic and therapeutic capabilities in primary care hospitals, and a full-cycle closed loop encompassing rehabilitation support and psychological care collectively establish a mechanism that transitions from “being able to treat” to “achieving effective treatment, manageable control, and prolonged survival.”

Dr. Donington pointed out, “Better integration of surgery with novel pharmaceuticals in China is expected to drive further breakthroughs and innovations in combined therapeutic pathways.” Building on the dual momentum of technological innovation and institutional synergy, the deep integration of diverse technologies—including surgery, pharmacotherapy, AI, and robotics—coupled with nationwide promotion of standardized diagnostic and treatment protocols and rehabilitation support, holds promise for truly achieving patient-centered, end-to-end optimized management. This approach could provide a replicable model for lung cancer prevention and treatment in China and globally.

Multi-Technology Integration

“Tailored” Lung Cancer Treatment

According to the latest estimates from the International Agency for Research on Cancer’s Global Cancer Observatory, nearly two-thirds of new cancer cases and deaths worldwide in 2022 were attributable to the ten most common cancers. Among these, lung cancer ranked first due to its high incidence and mortality rates: there were 2.5 million new cases, accounting for 12.4% of all new cancer cases globally, and 1.8 million deaths, representing 18.7% of all cancer-related deaths, firmly establishing it as the leading cause of cancer mortality.

Amid the heavy burden of disease, lung cancer treatment is increasingly moving toward “precision” and “individualization.”

Dr. Donington pointed out: “Regardless of the country, the formulation of lung cancer treatment pathways is fundamentally determined by three key factors: first, disease staging; second, the patient’s physical condition; and third, the molecular characteristics of the tumor.”

In the early stages of lung cancer, surgical resection remains the mainstream treatment modality, while technological advancements are driving the minimally invasive paradigm of “less trauma and reduced tissue damage.”

“In the early stages, some of our new concepts and methods focused on treatment approaches that were less invasive and destructive to patients’ wounds. At the same time, we also committed to developing diagnostic and therapeutic strategies involving smaller extents of lung resection,” said Dr. Donington.

In the intermediate stage, treatment regimens become more complex and diversified, requiring multidisciplinary collaboration and precise clinical judgment.

“In cases of locally advanced disease, we may combine radiation therapy or surgery with anticancer drugs, determining the sequence based on the specific clinical presentation,” Dr. Donington further added. “This is entirely dependent on each patient’s individual circumstances, necessitating the development of personalized treatment plans.” This “tailored-to-need” approach is gradually becoming the mainstream standard.

For patients with advanced or metastatic lung cancer, systemic therapy has become the cornerstone of clinical management, encompassing traditional chemotherapy, molecularly targeted agents, and immunotherapies that have continued to evolve in recent years.

“Currently, antibody-drug conjugates (ADCs) represent the most promising new direction, as they can target cancer cells more directly while reducing side effects on other parts of the body,” Dr. Donington specifically pointed out.

It is understood that multiple domestically produced ADCs in China have entered the development stage for lung cancer indications, with related research and international cooperation advancing simultaneously.

For example, Ruikang Trastuzumab, developed by Hengrui Medicine, has demonstrated significant efficacy in patients with previously treated HER2-mutant advanced or metastatic non-small cell lung cancer (NSCLC). The latest research data show that the median follow-up time has reached 14.2 months, and the objective response rate (ORR) assessed by the Independent Review Committee (IRC) is as high as 74.5%, setting a new global record for similar studies and injecting strong momentum into domestically produced innovative drugs in the field of lung cancer treatment.

HS-20093, an antibody-drug conjugate (ADC) targeting B7-H3 developed by Hansoh Pharmaceutical, has subsequently been granted “Breakthrough Therapy” designation by both the U.S. Food and Drug Administration (FDA) and China’s National Medical Products Administration (NMPA), further underscoring the rising potential of China’s domestic ADC innovation capabilities on the international stage of lung cancer treatment.

It is worth noting that the full-cycle diagnosis and treatment of lung cancer are entering a technology-driven era of innovation. From early screening and intraoperative treatment to postoperative rehabilitation management, the continuous integration of multidimensional technologies—including advances in medical imaging, surgical robotics, artificial intelligence, and personalized medicines—is making lung cancer therapy increasingly intelligent, efficient, and precise.

Among these, the application of surgical robots and bronchial robot systems is particularly noteworthy.

In the United States, surgical robots such as the da Vinci system are highly mature, with a long history of clinical application.

Dr. Donington stated that robotic surgery has become a highly routine practice, virtually ubiquitous, evolving from its initial trials in animal studies to its widespread clinical application today.

Meanwhile, robotic bronchoscopy systems are gradually entering clinical practice. Equipped with visualized probes, stable mechanical control, and precise navigation capabilities, these systems can more accurately locate nodules deep within the lungs, effectively reduce puncture errors, and improve the diagnostic yield for peripheral pulmonary nodules. In recent years, some hospitals in China have introduced such systems for biopsy pilot programs, demonstrating significant diagnostic value.

Beyond hardware innovations, artificial intelligence is gradually permeating the diagnosis and treatment workflow of lung cancer, demonstrating particular potential in enhancing information processing efficiency and supporting clinical decision-making. Dr. Donington shared an AI tool currently in use at the University of Chicago—Phoenix AI. This system assists physicians in generating medical record summaries and consultation notes. Specifically developed for use within closed-loop healthcare systems, it offers greater privacy and security guarantees compared to open AI platforms. The application of such tools is helping to “liberate” physicians from burdensome administrative tasks, thereby freeing up more time for focused clinical care.

However, in contrast to the routine application of surgical robots in lung cancer treatment, artificial intelligence currently remains in an exploratory and assistive phase.

“Regarding artificial intelligence (AI), it has not yet been widely adopted in the treatment of thoracic surgical conditions. I believe its potential lies primarily in providing insights into areas such as the molecular structure of cancers and radiotherapy data; it may offer valuable data support in the future, but there are currently no significant practical applications,” Dr. Donington admitted.

System Establishment

Survivors Are No Longer "Marginalized"

Within the broader landscape of lung cancer prevention and treatment, the deeper driving force behind technological innovation stems from the synergistic development of institutional frameworks, resource allocation, and patient care systems.

Since 2010, China has successively launched multiple national-level screening programs targeting high-risk populations, including the Rural Cancer Screening Program (RuraCSP), the Urban Cancer Screening Program (CanSPUC), and the National Cancer Early Screening Trial. Taking RuraCSP as an example, the program has covered high-incidence villages and towns across multiple provinces, increasing the diagnosis rate of early-stage lung cancer (Stage I) from 37.5% in 2014 to 75% in 2019. These achievements have provided a solid data foundation and practical validation for lung cancer prevention and control.

At the policy level, the Healthy China Action (2019–2022) has elevated cancer prevention and control to a national strategy, explicitly mobilizing public participation in cancer prevention and control. It deploys measures to strengthen cancer preventive screening, early diagnosis and treatment, and key scientific research, focusing on addressing challenges in cancer prevention and control. Concentrating superior resources, it aims to achieve significant breakthroughs in key areas such as pathogenesis, prevention and treatment technologies, resource allocation, and policy support.

Dr. Donington stated bluntly that truly effective diagnostic and treatment pathways must rely on “structured system support, particularly in post-screening follow-up management, rehabilitation system development, and multidisciplinary collaboration.”

“In the United States, all screening programs must be accompanied by follow-up management measures. Otherwise, patients will not only fail to receive continuous medical support but also be unable to have related costs reimbursed by insurance. This has also posed significant challenges to our promotion of national screening programs, such as patients lacking insurance coverage or being unable to access systematic screening and management due to living in remote areas,” pointed out Dr. Donington.

By contrast, China’s advantage lies in its strong healthcare accessibility. Dr. Donington further explained, “CT scanners are highly prevalent in China, available in nearly every hospital, and the cost of CT examinations is significantly lower than in the United States. This gives China a certain leading edge in early detection capabilities. However, China currently lacks a systematic and structured follow-up management system, and standardized pathways for post-screening tracking and interventions have yet to be established.”

If screening can be integrated with structured management, China’s advantages in early screening and diagnosis of lung cancer will become even more pronounced. Therefore, Dr. Donington suggests that China establish a project-based, systematic screening mechanism for high-risk populations. “For example, while screening smokers, smoking cessation support should be provided simultaneously, combining prevention with diagnosis, which is crucial for reducing the overall incidence rate.”

It is reported that China has made tangible progress in gene-based screening. In particular, individuals with no history of smoking but with a family history of lung cancer have been included in high-risk screening programs, representing the most practical approach to implementing genetic screening or genetic engineering technologies.

Meanwhile, with the further enhancement of diagnostic and treatment capabilities, it is imperative to promote the decentralization of high-standard lung cancer treatment models to primary care institutions.

In Dr. Donington’s view, Chinese thoracic surgeons possess a high level of technical expertise and have gained widespread international recognition.

“However, there is still room for improvement in China regarding the combined application of surgery and new drugs. Strengthening continuing education in this area, particularly in primary care hospitals and small to medium-sized cities, can help more patients benefit from integrated treatment pathways.”

Therefore, it is crucial to strengthen training and follow-up for primary healthcare institutions on lung cancer multidisciplinary team (MDT) workflows, clinical practice guidelines, and innovative technologies, ensuring that high-standard diagnosis and treatment are no longer confined to major cities.

It is worth noting that for cancer patients, what is needed is not only a successful surgery but also long-term follow-up and quality-of-life management.

According to Dr. Donington, most cancer patients in the United States enter a “lifelong surveillance” system, partly because they face a higher risk of developing second primary cancers, and partly because the disease may lead to declined physical function or psychological trauma, creating an urgent need for systematic support.

In the field of lung cancer, “cancer survivorship management” is still an emerging concept. Dr. Donington explains, “This is because there were very few long-term survivors of lung cancer in the past. Now, with advances in treatment, their numbers are increasing, compelling us to prioritize their postoperative quality of life and emotional support. This is particularly important for a subset of non-smoking lung cancer patients, who tend to be younger, healthier, and have stronger social functioning; thus, maintaining their quality of life during treatment is of utmost importance.”

Fortunately, this concept is gradually being implemented in China. A growing number of hospitals and non-profit organizations are incorporating postoperative management, psychological support, and functional rehabilitation into a “full-cycle care” system. A qualitative study of blogs by lung cancer survivors in China also revealed that patients frequently express significant concern regarding postoperative quality of life, psychological support, and social participation.

A study on early screening, precise diagnosis, and personalized treatment of lung cancer in China also reflects this systematic approach. This protocol encompasses multiple stages, including risk assessment, thin-slice three-dimensional reconstruction of low-dose CT (Tre-LDCT) for screening, AI-assisted diagnosis, biomarker analysis, and design of personalized treatment pathways, thereby covering the entire management chain from early screening to follow-up care. Results showed that after implementation of this model, the detection rate of early-stage (Stage I) lung cancer in China increased from 46.3% to 65.6%, with a five-year survival rate reaching 90.4%.

As China gradually completes the transition from “technology-driven” to “systemic synergy” in building its lung cancer prevention and control system, starting with highly accessible screening methods and integrating precise diagnostic tools, multidisciplinary collaborative treatment pathways, and increasingly robust rehabilitation and follow-up mechanisms, it is poised to offer valuable insights for global lung cancer prevention and control, while also helping patients achieve longer, higher-quality survival.