Many Patients With Metastatic NSCLC Remain Untreated Despite Therapeutic Advances

Despite major advances in immunotherapy and targeted therapy for metastatic non–small cell lung cancer (mNSCLC), a substantial proportion of older adults in the United States still never receive systemic treatment, according to findings published in JAMA Oncology.¹ Investigators said that the data highlight persistent gaps in referral patterns, access to care, and perceptions surrounding lung cancer treatment outcomes.

Nearly Half of Older Adults Did Not Receive Systemic Therapy

In the retrospective cohort study, investigators evaluated treatment patterns among adults aged 66 years and older diagnosed with mNSCLC between January 2006 to December 2021 using Surveillance Epidemiology and End Results (SEER)-Medicare data.¹ Researchers found that about half of patients did not receive systemic anticancer therapy, despite increasing availability of therapies associated with improved survival and quality of life outcomes.

The study was led by Adam Fox, MD, and Gerard Silvestri, MD, both of whom are lung cancer pulmonologists at Medical University of South Carolina Hollings Cancer Center, on behalf of the American Cancer Society National Lung Cancer Roundtable.² Investigators initially intended to evaluate biomarker testing rates but realized they first needed to determine how many patients actually underwent treatment evaluation.

“The thing we really wanted to look at was the prevalence of biomarker testing,” Fox explained in a news release from Hollings Cancer Center. “And we said, ‘Well, before we look at how many people get tested, we should start to know how many people even get treated.’”²

Researchers noted that oncologists often assume most patients receive therapy because individuals who successfully reach specialty oncology centers are more likely to undergo treatment; however, the findings suggest many patients never see an oncologist at all.²

“The take-home message for physicians is [to] get patients to an oncologist—quickly—so that we can see if they’re eligible for one of these new treatments,” Silvestri explained.²

Advances in Therapy Have Not Fully Translated Into Practice

Over the study period, treatment options for mNSCLC evolved dramatically, shifting from primarily cytotoxic chemotherapy toward immunotherapy and biomarker-driven targeted agents.^1,2 These therapies have transformed outcomes for many patients, with some targeted treatments extending survival by years in appropriately selected populations.²

Despite these advancements, investigators described the increase in treatment utilization over time as “unimpressive.” Many patients continued to go untreated even during years when immunotherapy became broadly available.²

Investigators identified several possible contributors to undertreatment. Approximately 40% of patients in the study died within 90 days of diagnosis, suggesting many individuals presented with advanced disease and declining performance status that limited treatment eligibility. Investigators emphasized that earlier detection remains critical, particularly given the high proportion of patients who died shortly after diagnosis.²

Emerging evidence suggests broader screening strategies could substantially improve outcomes. In a separate cohort study published in JAMA Network Open and covered by Pharmacy Times, researchers found that current US Preventive Services Task Force screening criteria identified only 35.1% of patients who ultimately developed lung cancer.^3,4

An expanded age-based screening model could identify nearly 94% of lung cancer cases and potentially prevent more than 26,000 deaths annually. Researchers noted that current smoking-based eligibility criteria may disproportionately miss women, Asian individuals, never-smokers, as well as racial and ethnic minority populations, contributing to delayed diagnoses and advanced-stage disease presentation.^3,4

The study also highlighted potential social and systemic barriers, including transportation challenges, treatment at underresourced facilities, and limited caregiver support.² Married patients were more likely to receive treatment, consistent with previous research showing social support influences cancer care engagement.¹

Additionally, outdated perceptions surrounding lung cancer therapy may discourage patients from pursuing treatment.² Historically, chemotherapy for advanced lung cancer carried substantial toxicity with limited survival benefit. However, the investigators stressed that modern therapies could offer more tolerable safety profiles and meaningful clinical improvements.

Pharmacists Play a Critical Role in Treatment Access and Education

The findings underscore the expanding role pharmacists can play in supporting timely treatment initiation and patient education for mNSCLC. Pharmacists are increasingly involved in molecular testing coordination, adverse effect management, immunotherapy monitoring, and medication counseling, particularly as treatment regimens become more personalized.

Experts noted that nearly all patients with metastatic NSCLC may be candidates for immunotherapy, even in the absence of actionable mutations.² Timely biomarker testing and referral to oncology specialists remain essential for identifying appropriate treatment strategies.

Pharmacists may also help address misconceptions regarding the tolerability and efficacy of modern therapies while reinforcing adherence and supportive care measures. As immunotherapy and targeted therapy continue to reshape the lung cancer treatment landscape, multidisciplinary efforts aimed at improving access and reducing delays in care may help close persistent treatment gaps among older adults.

“Lung cancer remains the leading cause of cancer-related deaths in this country,” Silvestri said. “The onus is on the medical community to diagnose disease early, refer to an oncologist quickly, and recognize and communicate to patients that there are available treatment options that can improve both quality of life and survival.”²

REFERENCES

1. Fox AH, Ward RC, Alexander M, et al. Rates of Systemic Treatment for Metastatic Non-Small Cell Lung Cancer Among Older Adults. JAMA Oncol. Published online May 7, 2026. doi:10.1001/jamaoncol.2026.1080

2. Cantu, L. Despite breakthroughs, many go without treatment for metastatic lung cancer. Hollings Cancer Center. May 7, 2026. Accessed May 12, 2026. https://hollingscancercenter.musc.edu/content-hub/News/2026/05/07/despite-breakthroughs-many-go-without-treatment-for-metastatic-lung-cancer

3. Yang HC, Chang A, Visa M, et al. Age-Based Screening for Lung Cancer Surveillance in the US. JAMA Netw Open. 2025;8(11):e2546222. doi:10.1001/jamanetworkopen.2025.46222

4. Gerlach, A. Age-based Lung Cancer Screening Could Dramatically Improve Early Detection. Pharmacy Times. November 28, 2025. Accessed May 12, 2026. https://www.pharmacytimes.com/view/age-based-lung-cancer-screening-could-dramatically-improve-early-detection