June Hong Ahn

Lung cancer remains the most common malignancy in Asia and is characterised by a substantial proportion of cases occurring in never-smokers, a feature that distinguishes the region from many Western populations. Only 20– 25% of patients with newly diagnosed non‑small cell lung cancer (NSCLC) present with resectable disease. As precision oncology expands into earlier stages, understanding how global standards can be adapted to Asian healthcare systems is increasingly important. This expert consensus report summarises evidence-informed opinions and voting outcomes from 13 lung cancer specialists across 11 countries to identify regional priorities, practical implementation needs, and management strategies for early and locally advanced NSCLC. Experts supported annual low‑dose CT (LDCT) screening for high‑risk individuals, with adaptation of criteria to better capture Asia’s substantial burden of never‑smokers and individuals with strong family history. Early diagnostic pathways emphasised rapid tissue acquisition and timely biomarker testing specifically EGFR, ALK, and PD‑L1 at initial diagnosis for both resectable and unresectable disease. Across resectable stage II–III disease, evidence from multiple Phase III trials consistently demonstrates that integrating immunotherapy with neoadjuvant or perioperative chemotherapy improves pathological response and event‑free survival, while maintaining surgical feasibility. Differences between regimens relate largely to timing, agent selection, and biomarker effects, and practical adoption in Asia varies according to diagnostic capacity and local resource availability. For unresectable stage III NSCLC, concurrent chemoradiotherapy followed by consolidation durvalumab remains standard, while recent data from the LAURA trial support consolidation osimertinib after CRT for EGFR-mutated disease, with a marked progression-free survival benefit (HR 0.16). Shared regional gaps include limited screening uptake, variable reimbursement for molecular testing and targeted therapies, and uneven access to multidisciplinary care. Collectively, the available evidence suggests that earlier biomarker testing, structured nodule management pathways, and broader access to perioperative and consolidation therapies can meaningfully improve outcomes in Asian populations. Strengthening MDT integration and harmonising diagnostic and therapeutic workflows across settings remain essential next steps.

Background/Objectives: Blood-based biomarkers may improve risk stratification of indeterminate pulmonary nodules detected on low-dose computed tomography (LDCT). We evaluated the diagnostic performance and independent predictive value of an aptamer-based blood assay, AptoDetect™-Lung, in a high-risk Korean screening population. Methods: This multicenter prospective cohort study enrolled adults with Lung Imaging Reporting and Data System (Lung-RADS) category 3 or 4 pulmonary nodules identified on LDCT across ten tertiary hospitals in South Korea between June 2023 and December 2024. Analyses focused on a predefined high-risk subgroup meeting Korean screening criteria (age 54–74 years and ≥30 pack-years of smoking). Baseline serum AptoDetect™-Lung scores were measured. Associations with lung cancer diagnosis were assessed using univariate and multivariable logistic regression, adjusting for clinical and radiologic variables. Diagnostic performance was evaluated using receiver operating characteristic analysis. Results: Among 1084 participants with histopathologic confirmation, 319 met high-risk criteria, of whom 260 (81.5%) were diagnosed with lung cancer. In this subgroup, the AptoDetect™-Lung score was independently associated with malignancy after adjustment (adjusted odds ratio of 1.14 per unit; 95% confidence interval of 1.02–1.27; p = 0.020). Discriminative performance was higher in the high-risk subgroup than in the overall cohort (area under the curve [AUC] of 0.639 vs. 0.570; p = 0.025). Performance was higher for squamous cell carcinoma and small-cell lung cancer than for adenocarcinoma. A multivariable model incorporating biomarker score, Lung-RADS category, age, and family history achieved an AUC of 0.710. Conclusions: An aptamer-based blood biomarker may provide modest adjunctive value for risk stratification in high-risk individuals.

Background: The AptoDetect™-Lung assay is an aptamer-based test designed for risk assessment in patients with pulmonary nodules, but its potential role in predicting lung cancer stage has not been evaluated. We investigated whether the assay could predict advanced-stage disease beyond conventional diagnostic modalities. Methods: This multicenter prospective cohort study enrolled 1672 patients with Lung-RADS 3–4 pulmonary nodules across ten university-affiliated hospitals in South Korea between June 2023 and December 2024. Among them, 934 patients with histologically confirmed lung cancer were retrospectively selected, and 852 patients were included in the final analysis after exclusions. The AptoDetect™-Lung assay was performed before invasive diagnostic procedures. Results: Among the 852 patients, 450 (52.8%) had advanced-stage disease. The AptoDetect™-Lung score was significantly higher in advanced-stage than in early-stage lung cancer (median, 6.2 vs. 2.8, p < 0.001). In a multivariable logistic regression analysis, a high AptoDetect™-Lung score (≥5) was independently associated with advanced disease (odds ratio 1.99, 95% confidence interval 1.35–2.95, p < 0.001). The AptoDetect™-Lung assay showed moderate discrimination of advanced-stage disease (area under the curve [AUC] 0.696) and in non–small cell lung cancer (AUC 0.720), whereas its discriminative ability was limited in small cell lung cancer (AUC 0.561). A combined prediction model incorporating the AptoDetect™-Lung assay, serum CEA, and radiologic findings demonstrated improved discriminative performance (AUC 0.821). Conclusions: The AptoDetect™-Lung assay score was independently associated with advanced-stage lung cancer and could provide clinically useful information for early risk stratification before definitive diagnosis and staging are available.

Jang JG, et al. J Korean Med Sci. 2026 Aug;41:e259. https://doi.org/10.3346/jkms.2026.41.e259

Background: The ADAURA trial demonstrated the efficacy of adjuvant osimertinib in patients with resected, early-stage, epidermal growth factor receptor (EGFR)-mutated non-small cell lung cancer (NSCLC). However, the role of adjuvant chemotherapy followed by osimertinib for patients with high-risk, EGFR-mutant stage IB (Methods: This retrospective study analyzed the medical records of patients with pathologic stage IB (T2aN0M0, EGFR-mutant adenocarcinoma of the lung who had high-risk factors and underwent surgical resection between January 2010 and January 2017. We evaluated the clinical impact of adjuvant chemotherapy and analyzed risk factors associated with recurrence-free survival (RFS) and overall survival (OS). Results: Of the 178 patients, 42 (23.6%) and 136 (76.4%) were in the adjuvant chemotherapy and non-adjuvant chemotherapy groups, respectively. Median RFS was 55 and 97 months in the adjuvant chemotherapy and non-adjuvant chemotherapy groups, respectively (P=0.22). Notably, 2-, 5-, and 10-year RFS rates were 71.4%, 49.9%, and 35.7% for the adjuvant chemotherapy group and 78.9%, 57.3%, and 49.9% for the non-adjuvant chemotherapy group, respectively. Multivariate analysis identified age ≥60 years, lymphovascular invasion, and micropapillary/solid predominant patterns as independent predictors of recurrence. Conversely, overweight patients (body mass index ≥25 kg/m²) had a lower risk of recurrence. Median OS was 134 and 145 months in the adjuvant chemotherapy and non-adjuvant chemotherapy groups, respectively (P=0.84). Multivariate analysis identified age ≥60 years and micropapillary/solid predominant patterns as independent predictors of OS. Conclusions: The efficacy of adjuvant chemotherapy in patients with stage IB (EGFR-mutant adenocarcinoma and high-risk features remains uncertain.

Introduction: The clinical application of lazertinib, a third‐generation epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor, has extended to the treatment of EGFR‐mutant non‐small‐cell lung cancer (NSCLC); however, the effects of its dose modification on its efficacy and safety have not yet been adequately established.Methods: This prospective, multicenter, observational cohort study aims to evaluate the clinical implications of adjusting the lazertinib dose. Patients will be categorized into two groups based on the lazertinib dose administered during the initial 12 weeks of treatment in routine clinical practice: 160 and 240 mg groups. The primary endpoints are progression‐free survival in the 160 mg group and identifying risk factors associated with dose modification during the 12‐week period.Discussion: The findings from the present study will provide real‐world insights into the clinical factors leading to lazertinib dose adjustments and deepen our understanding of the efficacy and safety of lazertinib in patients with NSCLC. Our research will contribute toward optimizing medical strategies for NSCLC treatment and aid clinicians in making accurate clinical decisions regarding dose modifications in routine practice.

Original Article Factors predicting early recurrence in patients with unresectable stage III non-small cell lung cancer on durvalumab consolidation after chemoradiotherapy Ji Eun Park, Chanmi Kim, Sun Ha Choi, Jong Geol Jang, Kyung Soo Hong, Yong Shik Kwon, Keum-Ju Choi, Jung Seop Eom, Saerom Kim, Hee Yun Seol, Jehun Kim, Insu Kim, Jin Han Park, Tae Hoon Kim, June Hong Ahn

Background: Salvage surgery following epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor therapy is a viable treatment option for selected patients with initially unresectable non-small cell lung cancer (NSCLC) harboring EGFR mutations. Case Description: We herein describe a 63-year-old man who presented to the emergency department with a 1-week history of speech disturbance and was diagnosed with clinical stage T1cN2M1b, IVA NSCLC with an EGFR exon 21 L858R mutation. The patient underwent brain tumor resection followed by stereotactic radiosurgery and was treated with palliative lazertinib for 6 months. A radiologic complete response was observed in follow-up imaging, and salvage surgery was recommended after multidisciplinary consultation. Right upper lobectomy with mediastinal lymph node dissection revealed a pathologic complete response with no residual tumor cells. The patient remained disease-free for 1 year following lazertinib treatment. Conclusions: This case suggests that salvage surgery after treatment with lazertinib may be a safe and effective approach for NSCLC with common EGFR mutations.

Background/Objectives: Nontuberculous mycobacterial pulmonary disease (NTM-PD) is an important comorbidity of COPD. Although many studies have reported an association between COPD and NTM-PD, no clear estimate of the prevalence of COPD and its effects on survival times in patients with NTM-PD is available. This study aimed to investigate the prevalence of COPD and its impact on survival in patients with NTM-PD. Methods: All studies reporting the prevalence of COPD in patients with NTM between 1952 and 2021 were searched using PubMed in May 2023. The inclusion criteria were studies about patients with NTM and COPD. A random-effects meta-analysis was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Results: The pooled overall prevalence of COPD in patients with NTM-PD was 28% (95% confidence interval [CI], 22–35). Patients with NTM-PD were six times more likely to have COPD than those without NTM-PD (pooled odds ratio [OR], 6.26; 95% CI, 3.37–11.65). Male patients with NTM-PD had a four-fold higher risk of COPD than females (OR, 3.81; 95% CI, 1.18–12.35). The co-existence of COPD and NTM-PD was significantly associated with an increased risk of mortality compared with NTM-PD without COPD (OR, 3.65; 95% CI, 1.28–10.40). Conclusions: COPD is common in patients with NTM-PD, and patients with NTM-PD had a six-fold increase in the odds of having COPD than those without NTM-PD. The presence of COPD and NTM-PD had a significant negative effect on survival. These findings may support the need to assess the presence of COPD in patients with NTM-PD and the potential negative effects associated with the co-existence of COPD and NTM-PD.

Background: Chronic obstructive pulmonary disease (COPD) is associated with frequent complications after transthoracic biopsy. Radial probe endobronchial ultrasound-guided transbronchial lung biopsy (RP-EBUS-TBLB) is widely used to diagnose peripheral pulmonary lesions (PPLs). However, the efficacy and safety of this procedure for the diagnosis of PPLs in patients with COPD remain poorly understood. We investigated the usefulness of RP-EBUS-TBLB for diagnosing PPLs in patients with COPD. Methods: This retrospective observational study aimed to identify clinical outcomes of RP-EBUS-TBLB in patients with COPD. A total of 175 patients with COPD and 439 patients without COPD were included in this study. RP-EBUS-TBLB was performed without fluoroscopy using a guide sheath. Results: The overall diagnostic accuracies in patients with COPD and without COPD were 80.6% (141/175) and 78.8% (346/439), respectively. There was no significant difference in the diagnostic yield based on the severity of airflow limitation (80.0%, 81.4%, and 79.2% for mild, moderate, and severe to very airflow limitations, respectively; P=0.97). In patients with COPD, diagnostic yields for malignant and benign lesions were 85.6% (95/111) and 71.9% (46/64). In multivariable analyses, larger lesion size [≥30 mm; odds ratio (OR), 2.86; 95% confidence interval (CI): 1.10–7.45; P=0.03] and within the lesion on EBUS image (OR 9.29; 95% CI: 3.79–22.79; PConclusions: RP-EBUS-TBLB can be used as an appropriate method to diagnose PPLs in patients with COPD. The size of the lesion (≥30 mm) and having the probe within the lesion were important for successful diagnosis. The location of the lesion in the upper lobe is associated with diagnostic failure. No difference was observed in the diagnostic yield based on the severity of airflow limitation. The complication rates were acceptable.