Is It Premature to Utter the Word 'Cure' in Advanced Lung Cancer?

One of the core tenets in medicine is that there's no always or never. In fact, I spent much of the past two decades explaining to patients in my thoracic oncology clinic that stage IV lung cancer isn't curable, but it is treatable. This cancer would come back even after our most promising responses in this setting.

Somewhere in the past few decades, however, the foundation of what I knew has shifted radically. Patients with metastatic lung cancer typically used to live for months; now, with immunotherapies, targeted therapies, and lower-risk local therapies, we expect more and more of these patients to live for years.

So I suppose I shouldn't be surprised that oncologists may now find themselves debating whether metastatic lung cancer is still a categorically incurable disease.

Outcomes in some patients with advanced lung cancer are defying our expectations. And now that patients are shattering 5-year survival barriers, I would argue that we should consider a subset of patients with metastatic non–small cell lung cancer (NSCLC) effectively cured.

And yet, I see remarkably little discussion of this question in professional meetings, journal articles, or conversations among colleagues in the clinic.