Kathmandu
Cancer Center
Kathmandu
Cancer Center
Nepal's most comprehensive lung cancer programme — molecular profiling, EGFR & ALK targeted therapy, PD-L1 immunotherapy IMRT and VMAT — all at KCC Kathmandu.
The type of lung cancer determines the entire treatment approach — which is why accurate pathological diagnosis before starting treatment is non-negotiable.
The most common type. Treated with targeted therapy (if mutation present), immunotherapy, chemotherapy, surgery, or radiation — often in combination. Further divided into:
Almost exclusively in heavy smokers. Extremely aggressive — most patients present with extensive stage disease. However, SCLC responds dramatically to chemotherapy (carboplatin + etoposide) and now immunotherapy (atezolizumab or durvalumab). Prophylactic cranial irradiation may be offered to prevent brain metastases.
Do not start chemotherapy for advanced NSCLC without molecular testing. If you have an EGFR mutation and are given chemotherapy instead of osimertinib, you are receiving a less effective treatment with more side effects.
If you have received a lung cancer diagnosis elsewhere — in Nepal or India — and molecular testing was not done or you are unsure of the results, contact KCC for a second opinion before starting treatment.
Every patient diagnosed with advanced NSCLC at KCC receives a comprehensive biomarker panel before any treatment decision:
The most significant advance in lung cancer treatment in the last decade. These treatments have transformed stage IV lung cancer from a condition with median survival of 12 months to one where many patients live 3–5 years or more — sometimes with minimal side effects.
Before any treatment begins, KCC performs molecular profiling of your tumour. This 7–10 day process identifies whether your cancer has a specific genetic driver — a mutation the cancer is "addicted" to — that can be switched off by a targeted oral tablet. If no mutation is found, we test PD-L1 expression to guide immunotherapy decisions. One test. One result. One personalised treatment plan.
If your tumour has an EGFR, ALK, ROS1, KRAS, MET, BRAF, RET, or HER2 mutation — a matching oral tablet targets the cancer directly. Far fewer side effects than chemotherapy. Most patients take a once-daily pill at home.
If no targetable mutation is found, PD-L1 expression guides immunotherapy. High PD-L1: pembrolizumab monotherapy. Any PD-L1: chemo-immunotherapy combinations. Durable responses in some patients — 20–30% remain progression-free at 5 years.
Each mutation is matched to a specific drug class. This is why molecular testing is not optional — it is the first step of treatment.
Immunotherapy works by removing the "brake" cancer puts on the immune system, allowing the body's own T-cells to recognise and destroy cancer cells. Unlike chemotherapy, responses can be durable — some patients remain in remission years after stopping treatment. PD-L1 expression on the tumour determines the most appropriate approach.
Patients with high PD-L1 expression and no targetable mutation are excellent candidates for pembrolizumab alone — no chemotherapy needed. KEYNOTE-024 trial showed 30% of patients had durable long-term responses.
For patients with lower PD-L1 or squamous histology, combining a checkpoint inhibitor with platinum-based chemotherapy delivers superior outcomes to chemotherapy alone, regardless of PD-L1 level.
For patients with unresectable stage III NSCLC who complete concurrent chemoradiotherapy without progression, KCC offers durvalumab (Imfinzi) consolidation immunotherapy for up to 12 months. The PACIFIC trial demonstrated a significant improvement in progression-free and overall survival with this approach.
For extensive-stage small cell lung cancer (ES-SCLC), KCC offers atezolizumab (IMpower133) or durvalumab added to platinum-etoposide chemotherapy as first-line treatment — the current international standard based on IMpower133 and CASPIAN trials. Maintenance atezolizumab or durvalumab continues until progression.
Chemotherapy remains an important part of lung cancer treatment — as first-line therapy when no targeted mutation is found and PD-L1 is low, in combination with immunotherapy, concurrent with radiation, or in later lines after targeted/immunotherapy progression.
Neoadjuvant (before surgery): Chemo ± immunotherapy can downstage tumours to make surgery possible — used in select stage IIIA patients.
Adjuvant (after surgery): Cisplatin-based chemotherapy is given after complete resection in stage II–III to reduce recurrence risk. Adjuvant osimertinib is now standard for resected EGFR-mutant NSCLC (ADAURA trial).
For unresectable stage III NSCLC — cisplatin or carboplatin + etoposide given simultaneously with daily IMRT for 6 weeks. Followed by durvalumab (Imfinzi) maintenance immunotherapy.
→ Stage III unresectable NSCLCShort courses (5–10 fractions) to relieve symptoms — bone pain from metastases, haemoptysis, superior vena cava obstruction, or airway compression. Dramatic symptom relief in 2–3 days.
→ Symptom controlFor limited-stage SCLC patients who respond to chemotherapy — whole-brain irradiation significantly reduces brain metastasis risk and may improve survival.
→ Limited-stage SCLCOccasionally used before surgery to reduce tumour bulk in borderline resectable cases. Post-operative radiation (PORT) for patients with mediastinal node involvement after resection.
→ Perioperative contextTreatment for lung cancer is always individualised — these are general frameworks. Your KCC oncologist will tailor the plan based on histology, molecular profile, performance status, and lung function.
| Stage | Description | Standard Treatment Approach at KCC |
|---|---|---|
| I (A/B) | Tumour confined to lung, no nodes | Surgery (VATS lobectomy / segmentectomy) · SBRT for medically inoperable · Adjuvant osimertinib if EGFR-mutant after resection |
| II (A/B) | Local nodes involved or larger tumour | Surgery + adjuvant chemotherapy (cisplatin-based) · Adjuvant osimertinib if EGFR-mutant · SBRT if inoperable · Neoadjuvant chemo ± nivolumab if borderline resectable |
| III A | Mediastinal nodes, potentially resectable | Multimodal: Neoadjuvant chemo ± immunotherapy (CheckMate816) → surgery · OR concurrent chemoradiation → durvalumab maintenance · Case-by-case MDT decision |
| III B/C | Extensive nodal disease, unresectable | Definitive concurrent chemoradiation (6 weeks) → Durvalumab maintenance x12 months · Osimertinib if EGFR-mutant and low PD-L1 |
| IV NSCLC | Metastatic — other organs involved | If driver mutation: Matched oral targeted therapy (osimertinib, alectinib, sotorasib etc.) · If PD-L1 high, no mutation: Pembrolizumab · If PD-L1 any: Chemo + immunotherapy combination · Local ablative RT to oligomets |
| ES-SCLC | Extensive small cell | Carboplatin + etoposide + atezolizumab (or durvalumab) x4 cycles → maintenance immunotherapy until progression · Prophylactic cranial irradiation for responders |
| LS-SCLC | Limited small cell (one hemithorax) | Concurrent cisplatin + etoposide with thoracic IMRT · Prophylactic cranial irradiation after response · Potentially curative intent |
From first consultation to complete molecular results and treatment plan — typically 10–14 days at KCC.
History, examination, review of existing reports and scans. Same day if WhatsApp appointment booked.
Detailed imaging of the tumour, mediastinal lymph nodes, and adjacent structures. Arranged same or next day.
Full-body metabolic staging — detects nodal and distant metastatic disease. Changes treatment intent in 20–30% of cases.
CT-guided lung biopsy (most common) · EBUS bronchoscopy for central tumours / mediastinal nodes · Bronchoscopic biopsy for endobronchial lesions · Liquid biopsy (blood ctDNA) if tissue inaccessible.
Tissue confirms NSCLC vs SCLC and subtype. Molecular testing (EGFR, ALK, ROS1, KRAS, MET, BRAF, RET, HER2, PD-L1, TMB) on same sample. Results in 7–10 days.
All results presented at weekly multidisciplinary tumour board. Personalised treatment plan discussed, documented, and explained to patient and family.
If you have been diagnosed elsewhere, KCC can review your biopsy slides and molecular results — or arrange re-testing if molecular profiling was incomplete. This is particularly important if you were not tested for EGFR, ALK, ROS1, and PD-L1 before starting treatment. Request a second opinion →
Lung cancer is often silent in early stages. Most patients in Nepal present with advanced disease because symptoms are dismissed as "smoker's cough" or a chest infection. If you or a family member has any of these symptoms — especially if a smoker — consult a doctor.
Who should be screened? Aged 50–80 · Smoked ≥20 pack-years (e.g. 1 pack/day × 20 years) ·
Current smoker or quit within last 15 years.
How? Annual low-dose CT (LDCT) scan — detects lung cancer at a curable stage,
before symptoms appear. The NLST trial showed 20% reduction in lung cancer mortality with LDCT screening.
Ask KCC about lung cancer screening →
City Clinic — New Baneshwor · Main Campus — Tathali Bhaktapur