for these patients, with median os of 30 months with pembrolizumab single agent compared to 14.2 months with chemotherapy in keynote-024. atezolizumab for first-line treatment of metastatic nsclc with pd-l1 ≥ 50% was approved recently by the fda, after the impower110 trial showed a median os of 20.2 months for patients in the atezolizumab arm, compared with 13.1 months in the chemotherapy arm (p = 0.0106). for patients with tumor pd-l1 expression level of 1–49%, monotherapy with pembrolizumab as per keynote-042 is an appealing option, especially for smoker males. treatment of patients with metastatic non-small cell lung cancer (nsclc). first line immunotherapy for non-small cell lung cancer. keynote-024 keynote-024 was a phase 3 trial that compared pembrolizumab versus platinum-based chemotherapy-doublet for pd-l1 positive nsclc. the chemotherapy used was the investigator’s choice of platinum-based chemotherapy doublet. the trial included patients with squamous (18%) and nonsquamous (82%) histology with pd-l1 expression on at least 50% of tumor cells. most patients were current or former smokers (92%). median overall survival (os) was 30.0 months with pembrolizumab and 14.2 months with chemotherapy, hazard ratio 0.63, p = 0.002. pembrolizumab was associated with significantly fewer adverse events than was platinum-based chemotherapy. keynote-042 keynote-042 included nsclc patients with locally advanced or metastatic disease without previous treatment and without a driving mutation in egfr or alk translocation, and with pd-l1 tumor proportion score (tps) of 1% or greater. the trial included patients with squamous and nonsquamous histology, most of them current or former smokers. this phase 3 trial compared pembrolizumab versus the investigator’s choice of platinum-based chemotherapy doublet. median overall survival was 16.7 months with pembrolizumab and 12.1 months with chemotherapy, hazard ratio 0.81, p = 0.0018. keynote-189 this study compared chemotherapy to chemotherapy and pembrolizumab in patients with nonsquamous nsclc as first line therapy. the chemotherapy used was pemetrexed + cisplatin/carboplatin. among patients with nonsquamous nsclc with any pd-l1 expression level, overall survival was 22 versus 10.7 months with pembrolizumab and chemotherapy compared to chemotherapy alone, hr 0.56. keynote-407 keynote-407 compared chemotherapy to chemotherapy and pembrolizumab in patients with squamous nsclc as first line therapy. the chemotherapy used was carboplatin + paclitaxel or nab–paclitaxel. among patients with squamous nsclc with any pd-l1 expression level, os was 15.9 versus 11.3 months with pembrolizumab and chemotherapy compared to chemotherapy alone, respectively, hr 0.64. more than 92% of the patients were current or former smokers. impower110 impower110 randomized patients with stage iv nsclc with pd-l1 expression ≥ 1% to atezolizumab single agent or to chemotherapy. the chemotherapy used was cisplatin or carboplatin, combined with gemcitabine for patient with squamous cell nsclc, or pemetrexed for patients with nonsquamous disease. atezolizumab was better tolerated than chemotherapy. in the subgroup of patients with egfr and alk wild-type tumors who had pd-l1 stained ≥ 50% of tumor cells (205 patients), the os was 20.2 months with atezolizumab, and 13.1 months with chemotherapy. impower150 impower150 randomized patients with nonsquamous nsclc to treatment with chemotherapy plus bevacizumab, chemotherapy plus atezolizumab or chemotherapy plus bevacizumab and atezolizumab. the chemotherapy used was carboplatin, and paclitaxel. median os was 19.8 and 14.9 months for patients treated with chemotherapy plus bevacizumab, with or without atezolizumab, respectively. median os with atezolizumab and chemotherapy alone was 19.5 months, raising question with regard to the added value of bevacizumab to this combination for the general patients population. survival outcomes for stage 4 non-small lung cancer patients treated with immunotherapy alone or combined with chemotherapy in the first line: overall survival in non-small lung cancer patients treated with immunotherapy and/or chemotherapy in the first line for advanced or metastatic disease. results of the main treatment arms of phase 3 clinical trials. pembrolizumab (pembro), nivolumab (nivo), atezolizumab (atezo), bevacizumab (beva), ipilimumab (ipi), chemotherapy (chemo), months (m), hazard ratio (hr). source: first line immunotherapy for non-small cell lung cancer, nasser nj, gorenberg m, agbarya a. pharmaceuticals (basel). 2020 13(11):373.https://doi.org/10.3390/ph13110373 radiation in patients with stage one or two non-small cell lung carcinoma, radiotherapy alone results in 13–39% of patients surviving to five years. percutaneous ablation percutaneous image-guided ablation is a minimally invasive treatment that can be offered to patients with early stage nsclc or for palliative treatment for patients with metastatic disease. there are various types of ablation used for treating lung malignancies including radiofrequency ablation (rfa), cryoablation, and microwave ablation. thermal ablation is typically recommended for patients who are higher risk surgical patients due to cardiopulmonary disease. ablation is generally a lower risk procedure compared to surgery; it requires only local anesthesia and sometimes conscious sedation, and it is minimally invasive. the procedure is performed by interventional radiology in an outpatient setting. under ct or ultrasound guidance, a probe is advanced through the anesthetized skin until the tip of the probe is positioned within the tumor. extreme temperature is then created through electrical current (radiofrequency ablation and microwave ablation) or gas (cryoablation), which triggers destruction of the cancerous cells. major complications are uncommon, but include partial collapse of the lung and hemothorax. while there is growing evidence supportive of ablation as treatment for nsclc, high rates of local recurrence and new metastatic disease in the treatment areas leads to reliance on more traditional treatment modalities. the pitfalls of ablation stem from the lack of complete and homogenous destruction of tumor cells, often leading to residual malignant cells on the periphery of the tumor. for that reason, lesions greater than 5 centimetres (2.0 in) should be excluded, and lesions 3 to 5 cm (1.2 to 2.0 in) should be considered with caution, given high risk of recurrence. additionally, for safety reasons, lesions less than 1 cm (3⁄8 in) from the trachea, main bronchi, esophagus and central vessels should be excluded from rfa, given high risk of complications and frequent incomplete ablation. an animal tumor model demonstrated improved survival after combined treatment with rfa and radiation therapy compared to either treatment alone. it is possible that the two modalities have a synergistic effect and patients may benefit from combined treatment. history prior to the early part of the 20th century lung cancer was considered a very rare disease, and all malignant lung tumors were treated identically. radical surgical resection (i.e. lobectomy or pneumonectomy) was the only effective intervention available for lung cancer prior to the 1940s, when the era of modern cytotoxic chemotherapy began. palliative radiotherapy has been used since the 1940s. radical radiotherapy, initially used in the 1950s, was an attempt to use larger radiation doses in patients with relatively early-stage lung cancer, but who were otherwise unfit for surgery. with sclc, initial attempts in the 1960s at surgical resection and radical radiotherapy were unsuccessful. it was not until 1962 that small cell lung carcinoma (sclc), then called "oat cell carcinoma" was recognized for its unique biological behavior, including a much higher frequency of widespread metastases at presentation, and exquisite sensitivity to cytotoxic chemotherapy and radiation. early studies suggested that patients with small cell lung carcinoma (sclc) fared better when treated with chemotherapy and/or radiation than when treated surgically. while this approach to treating sclc remains the current standard of care, the role of surgery in sclc is being re-examined, with recent studies indicating that surgery may improve outcomes in some patients with early stage sclc and combined forms of sclc and nsclc. trials squalamine is undergoing trials for treatment of non-small cell lung cancer (stage i/iia). in december 2012, merck published the results of its current study. although the phase iii trial of l-blp25 (stimuvax) did not meet satisfying primary endpoints for patients with non-small cell lung cancer, notable treatment effects have been observed for l-blp25 in certain subgroups in the start study. funding of research from 2003-2014, a study conducted by the global lung cancer coalition found that the total number of articles published in independent journals regarding lung cancer treatment research only increased ~1%. money that is put forth for cancer research by taxpayers is generally misplaced into organizations such as the american cancer society rather than going to organizations that are specifically focused on a specific type of cancer. while lung cancer is the deadliest cancer, a stigma surrounds the disease that it is highly preventable by not smoking. lung cancer receives much less press time then other cancers such as breast cancer due to this stigma, with a survey of 1,000 participants finding that only 14% of those participants were the most concerned about lung cancer. this stigma has resulted in less time and money being put into treatment research and focusing more so on smoking prevention, despite lung cancer having a multitude of other causes such as genetics or air pollution. governing bodies place taxpayer funds into generalized organizations and the public focuses less heavily on the disease, resulting in less research into treatment.