First is immunotherapy. AstraZeneca announced on May 13, 2017, interim trial data for its PD-L1 antibody Imfinzi (durvalumab) in a phase III clinical trial called PACIFIC. which compared the effects of Imfinzi and placebo as maintenance therapy on median progression PFS and OS after chemotherapy or radiation therapy in patients with inoperable non-small cell lung cancer in stage III. The data showed significant PFS efficacy.OS was not yet available.Imfinzi, as the 5th FDA-approved PD-1/PD-L1 antibody drug (May 1, 2017, bladder cancer), chose intermediate-stage non-small cell lung cancer as a breakthrough point, a bold, risky, and highly commercially rewarding attempt to bring better treatment options to patients with intermediate-stage non-small cell lung cancer. The famous Chinese immunoscientist Prof. Chen Chen Ping once mentioned that PD-1 immunotherapy might be more effective for patients with intermediate and early stage cancer. However, due to the time consuming and risky clinical trials for patients with intermediate and early stage lung cancer, no one has been actively trying it. Or should I say early-stage immunotherapy leaders are addressing the needs of the most urgent advanced-stage patients first. Stage III patients account for about a quarter of non-small cell lung cancer patients, with inoperable patients accounting for about half of them, which projects to a global potential benefit population of up to 50,000/year. This is undoubtedly a great benefit for this still highly lethal population. AstraZeneca’s clinical trials of immunotherapy for earlier stage, non-metastatic or locally metastatic tumors have brought new ideas to the entire oncology immunotherapy industry and greatly enhanced the potential population for immunotherapy. Then there are targeted therapies. The proportion of EGFR-driven oncogenic mutations in advanced non-small cell lung cancer is about 15-18% in Europe and the United States, and the proportion is greatly increased in East Asian patients, up to 30-50%. According to the TCGA data, its enrollment population is mostly early to mid-stage smokers, and the proportion of people with EGFR-sensitive mutations is also 11.3% , and the proportion of non-smokers is even higher. Stage II-IIIA patients account for 27% of all NSCLC patients. The standard treatment for this group of patients is mainly surgical resection with chemotherapy to prevent recurrence. Because of the high recurrence rate after surgery, patients also have a very low five-year average survival rate of about 19-36%, a group that is in dire need of better therapies. In the United States, the standard therapy is to wait until patients progress to advanced stage IV before performing genetic testing and appropriate targeted therapies. So is surgery plus EGFR-targeted small molecule inhibitors an option for patients with early to mid-stage EGFR-sensitive mutations to reduce toxicity and improve survival benefit? It’s AstraZeneca again! The latest ASCO Annual Meeting revealed ahead of schedule (May 17, 2017) that in a 222-patient enrolled phase III clinical trial, patients treated with the EGFR first-line small molecule kinase inhibitor Gefitinib had a 10-month delay in relapse compared to patients receiving chemotherapy. The median time to relapse was 28.7 months in patients receiving postoperative adjuvant therapy with Gefitinib and 18 months in the adjuvant chemotherapy group, (hazard ratio [HR], 0.60; P = 0.005) statistically significant. The incidence of serious side effects was 12% in the Gefitinib compared to 48% in the chemotherapy group. Targeted drugs can significantly reduce the toxic side effects caused by treatment and improve the quality of patient survival. In this way, genetic testing for patients with non-small cell lung cancer should be expanded to include patients in earlier stages. Up to 140,000 potential patients worldwide could benefit from the use of EGFR-targeted therapies as adjuvant therapy, reducing the risk of surgical recurrence and improving survival. ASCO President Bruce E. Johnson highly commended the clinical trial of Gefitinib, emphasizing that the use of targeted therapies in patients with early to mid-stage non-small cell lung cancer could not only significantly reduce toxicities, but also provide a significant boost in survival benefit. Professor Yilong Wu, who led the clinical trial, also emphasized that more genetic mutation testing for early and middle-stage lung cancer should perhaps be more widely available, which could help patients choose better targeted therapies.