The treatment landscape for locally advanced lung cancer has changed more in the last four years than in the previous thirty. Six international phase 3 trials have established that combining chemotherapy, immunotherapy and surgery dramatically improves survival. More patients than ever before are candidates for curative-intent treatment. Dr Okiror delivers this full multi-modality pathway to private patients at London Bridge Hospital and The Lister Hospital Chelsea.
Last reviewed: April 2026 · Dr Lawrence Okiror FRCS(CTh) FRCSEd(CTh) · GMC 6150382
Locally advanced lung cancer refers to non-small cell lung cancer (NSCLC) — the type that accounts for approximately 85% of lung cancers — that has grown beyond the lung but has not spread to distant organs. It occupies the difficult middle ground between early-stage disease, where surgery alone may be curative, and advanced disease, where surgery has historically had little role.
For a generation, this was the tier where curative intent became uncertain. Many patients were deemed inoperable. Many who did undergo surgery faced removal of an entire lung. Outcomes were often disappointing.
That has changed. The sequenced combination of chemotherapy, immunotherapy and surgery has transformed what is achievable — for patients who reach the right centre, at the right time, with the right team.
These used to be considered difficult or sometimes impossible to cure with surgery. International trial data from the last four years has changed that position.
A note on lung cancer type. This page covers non-small cell lung cancer (NSCLC). Small cell lung cancer (SCLC) is biologically different and is treated primarily with chemotherapy and radiotherapy — it is rarely a surgical disease. Patients with SCLC should discuss treatment with a medical oncologist.
Between 2022 and 2025, six large phase 3 randomised trials established that adding immunotherapy to chemotherapy — either before surgery, or both before and after — significantly improves survival in locally advanced non-small cell lung cancer. The results have been consistent across populations, tumour types, and immunotherapy agents.
Neoadjuvant · 2022
Forde et al. · NEJM 2022 · Final OS ASCO 2025 · 358 patients
Neoadjuvant nivolumab with chemotherapy before surgery. Five-year overall survival 65% vs 55% with chemotherapy alone.
Perioperative · 2023
Wakelee et al. · NEJM 2023 · 797 patients
Perioperative pembrolizumab — before and after surgery. Four-year overall survival 68% vs 57%.
Perioperative · 2023
Heymach et al. · NEJM 2023 · 802 patients
Perioperative durvalumab. 32% reduction in risk of recurrence, progression or death.
Perioperative · 2024
Lu et al. · JAMA 2024
Perioperative toripalimab confirmed the benefit in stage IIIA/IIIB disease, consistent with the other trials.
Perioperative · 2025
Yue et al. · Lancet Respir Med 2025
Perioperative tislelizumab. A sixth positive trial reinforcing chemoimmunotherapy as the new standard.
EGFR-Mutated · Adjuvant · 2023
Herbst et al. · NEJM 2023 · 682 patients
For EGFR-mutated patients excluded from the chemoimmunotherapy trials: adjuvant osimertinib delivered 5-year survival 85% vs 73% — a 51% reduction in risk of death.
Six positive phase 3 trials in 48 months. All show the same signal: adding immunotherapy to surgery, in the right sequence, transforms survival in locally advanced lung cancer.
The National Institute for Health and Care Excellence (NICE) independently reviews the evidence before any new cancer treatment is approved for use in the UK. The trial data has already translated into national recommendations.
NICE TA876 · March 2023
Neoadjuvant nivolumab with chemotherapyRecommended for resectable lung cancers of 4cm or larger, or where lymph nodes are involved. Based on CheckMate 816.
NICE TA1037 · February 2025
Adjuvant osimertinib for EGFR-mutated lung cancerRecommended for EGFR-mutated lung cancer after complete surgical resection. Based on the ADAURA trial.
NICE TA1071 · June 2025
Adjuvant atezolizumab after resectionRecommended for PD-L1 positive lung cancer after surgery and adjuvant chemotherapy. Based on IMpower010.
NICE NG122 · Updated 2024
Lung cancer: diagnosis and management guidelineThe national framework requiring multidisciplinary team management, biomarker testing, and multi-modality treatment planning for resectable lung cancer.
NICE ID5094 · Appraisal in progress
Perioperative pembrolizumabCurrently under NICE appraisal based on KEYNOTE-671. Expected to extend the UK-approved pathway further.
NICE approval also informs private medical insurance coverage: treatments with NICE recommendations are generally included within mainstream PMI cancer benefits.
Three tests on the tumour tissue are essential before systemic treatment for locally advanced lung cancer: EGFR mutation, ALK rearrangement, and PD-L1 expression. Each one changes the treatment pathway.
EGFR and ALK identify cancers that respond better to targeted oral tablets than to chemoimmunotherapy. Patients with these mutations were specifically excluded from the chemoimmunotherapy trials — they have their own pathway, built on the ADAURA trial.
PD-L1 expression predicts how strongly the cancer will respond to immunotherapy. While chemoimmunotherapy benefits most patients regardless of PD-L1 level, high expression suggests particularly strong response.
If you have been offered systemic treatment without these test results, this is the single most important question to ask before starting.
If positive, the standard treatment is surgery followed by three years of osimertinib tablets — the ADAURA pathway.
If positive, targeted therapy with ALK inhibitors is the principle, and chemoimmunotherapy is generally avoided.
Reported as a percentage. Guides the choice of immunotherapy and, in some cases, whether adjuvant immunotherapy is appropriate.
These tests are performed routinely for every private patient Dr Okiror manages with operable lung cancer. Results typically return within one to two weeks and precede any treatment decision.
No single specialist should make a treatment plan for locally advanced lung cancer alone. The decisions on sequencing chemotherapy, immunotherapy, surgery and adjuvant treatment require input from multiple disciplines reviewing the same case together.
Dr Okiror is part of the lung cancer multidisciplinary team at London Bridge Hospital. He attends regularly as one of the thoracic surgeons in the meeting, which brings together:
Every case is reviewed collectively before a treatment plan is agreed. The oncology colleagues Dr Okiror works with at GSTT include investigators whose teams contributed to several of the landmark international trials now defining standard care.
Published experience: In 2025, Dr Okiror was a co-author of the Guy's Cancer Centre real-world series on neoadjuvant chemoimmunotherapy, published in Lung Cancer.
Toki M, Elkhalifa M, Bille A, Tan C, Ashrafian L, Okiror L, et al. Real world data analysis of neoadjuvant nivolumab in combination with platinum-based chemotherapy in operable NSCLC: the Guy's cancer centre experience. Lung Cancer 2025;200(Suppl 1):108200. doi: 10.1016/j.lungcan.2025.108200.
Surgery after three or four cycles of chemoimmunotherapy is more technically demanding than surgery on an untreated tumour. The tissues develop fibrosis — a form of scarring. The natural anatomical planes between structures that normally make keyhole surgery possible can become obliterated.
Many centres respond to this difficulty by converting the operation to open thoracotomy — a larger incision requiring rib spreading, significantly longer hospital stay, and markedly slower recovery.
This matters clinically because patients who have just completed four months of systemic therapy are the least able to tolerate a large open operation. The robotic approach — where it remains feasible — preserves their recovery, shortens their hospital stay, and returns them to daily life sooner.
At high-volume robotic centres, surgeons encounter these fibrotic cases routinely and develop the technique to dissect through them robotically. Dr Okiror's private patients at London Bridge Hospital benefit from this experience. Robotic lung surgery overview →
Dr Okiror consults and operates at both London Bridge Hospital and The Lister Hospital Chelsea.
For straightforward lung cancer surgery, either hospital offers excellent private care with full robotic capability.
For more complex cases — for instance, those forming part of multi-modality treatment — Dr Okiror typically recommends London Bridge Hospital, which has greater experience and deeper infrastructure for these operations.
Patients first seen at The Lister who are found to have more complex disease are not turned away. The surgical episode is transferred to LBH, while consultations and follow-up can continue at whichever hospital is more convenient.
Dr Okiror practises at Guy's and St Thomas' — one of the UK's largest thoracic surgery centres — where institutional clinical standards include:
1.4%
Pneumonectomy rate — among the lowest nationally, without compromising survival
>99%
Operative survival rate for primary lung cancer surgery
>70%
Robotic rate for anatomic resections — vs 24% national average
>90%
Minimally invasive rate for primary lung cancer anatomic resections
The 1.4% pneumonectomy rate is the single most important figure on this page. It means that at the centre where Dr Okiror trains his private practice standards, whole-lung removal is the exception — even in locally advanced cases. SCTS National Thoracic Audit, 2024–25.
The treatment landscape has changed so quickly that advice given even twelve months ago may no longer reflect current options. Two scenarios in particular warrant a fresh look.
Scenario One
The definition of "inoperable" has changed meaningfully in the last three years. Chemoimmunotherapy given before surgery can shrink tumours, clear involved lymph nodes, and convert previously inoperable cancers into operable ones.
If you received this advice more than twelve months ago, or if biomarker testing was not performed, the recommendation may need to be reviewed.
Request Second Opinion →Scenario Two
Pneumonectomy — removal of an entire lung — remains the right operation for some patients. For many others, particularly after chemoimmunotherapy shrinks the tumour, a lobectomy preserves more lung and delivers equivalent cancer control.
A second opinion may identify a lung-sparing alternative. Private consultations are typically available within 2–3 days.
Request Second Opinion →A note on insurance: Multi-modality treatment — neoadjuvant chemoimmunotherapy, biomarker testing, robotic surgery, adjuvant therapy — involves several components and hospital stays. Some insurance policies require prior authorisation for specialist cancer treatments. Patients are advised to check with their private medical insurer early in the pathway. Self-pay options are available for all elements of treatment; Jo Mitchelson can provide an estimate on request.
Common questions from patients and families considering multi-modality treatment for locally advanced lung cancer.
Book a Consultation →Or call Jo Mitchelson:
020 7952 2882
Appointments within 2–3 days. Self-referrals welcome. Surgery at London Bridge Hospital (complex cases) and The Lister Hospital Chelsea.
Jo Mitchelson, Private PA · 020 7952 2882 · pa@lungsurgeon.co.uk
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Long-form patient guide to multi-modality treatment — week by week, in accessible language
Second Opinion ServicePrivate second opinion appointments within 2–3 days — how to prepare and what to bring
Robotic Lung SurgeryOverview of the robotic lung cancer surgery service — lobectomy, segmentectomy, complex cases