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Lung adenocarcinoma — master index

Last curated: 2026-10-30 · condition status: audited 2026-08-29; swept 2026-10-16, 2026-10-23, and 2026-10-30, awaiting audit · page status: 6 curated, 12 draft · evidence cutoff: 2026-10-30

Corpus: 18 canonical wiki pages · 340 unique PubMed records in the bibliography (270 audited 2026-08-29 + 57 added 2026-10-16 + 1 added 2026-10-23 + 12 added 2026-10-30; sweep additions awaiting audit) · 59 ClinicalTrials.gov identifiers live-checked 2026-10-30 · 6 landmark notes · 1 guideline registry · 1 statistics ledger · 4 patient-voice files · 30 stable open questions · 12 cross-domain junctions.

The condition in five sentences

Lung adenocarcinoma is the dominant lung-cancer histology in most assessed populations and spans preinvasive AIS/MIA through metastatic disease; lung cancer remains the leading cause of cancer death globally (Travis 2011, PMID 21252716; Bray 2024, PMID 38572751; Luo 2025, PMID 39914442). Its defining clinical feature is molecular partition: EGFR, ALK, ROS1, RET, BRAF V600E, MET exon-14, NTRK, KRAS G12C, and HER2 states route patients into distinct treatments, while PD-L1 guides immune therapy only after actionable-driver testing is complete (TCGA 2014, PMID 25079552; Lindeman 2018, PMID 29398453). Low-dose CT reduces lung-cancer mortality in smoking-exposed high-risk populations, but never-smoker adenocarcinoma—molecularly diverse across geography and linked to pollution and other forces—remains outside smoking-based eligibility (NLST PMID 21714641; NELSON PMID 31995683; Díaz-Gay 2025, PMID 40604281). Curative-intent care now combines surgery or definitive radiation with stage- and genotype-aware perioperative therapy, including adjuvant osimertinib and alectinib and neoadjuvant/perioperative chemo-immunotherapy (ADAURA PMID 37272535; ALINA PMID 38598794; CheckMate 816 PMID 35403841). The frontier is no longer only finding targets: it is choosing lifetime sequences, preventing CNS and molecular relapse, using ctDNA without overtreatment, reducing ILD and immune toxicity, and making complete biomarker access and chronic survivorship equitable.

Sibling condition: lung squamous-cell carcinoma is the deliberate contrast. TNM, LDCT, surgery, chemoradiation, checkpoint toxicity, brain-metastasis care, and palliative care are shared NSCLC domains; histology, driver biology, chemotherapy selection, and targeted-therapy sequencing differ.

Start here: overview. Quantitative lookup: statistics. Research frontier: open questions. Provenance: bibliography. Growth history: curation log.

Reading paths

New to the condition

  1. Overview
  2. Histology and classification
  3. Staging
  4. Molecular landscape
  5. Systemic therapy

Diagnosis and testing

  1. Screening and early detection
  2. Histology and classification
  3. Staging
  4. Molecular testing
  5. Biomarkers

Driver-positive metastatic disease

  1. Molecular landscape
  2. EGFR disease
  3. ALK, ROS1, and fusion drivers
  4. KRAS, BRAF, MET, and HER2
  5. Systemic therapy
  6. Red flags and safety concerns

Driver-negative and immune therapy

  1. Molecular testing
  2. Immunotherapy
  3. Systemic therapy
  4. Biomarkers
  5. Guidelines

Curative-intent disease

  1. Staging
  2. Histology and classification
  3. Early-stage and perioperative therapy
  4. Biomarkers
  5. Guidelines

Implementation, lived experience, and safety

  1. Patient experience and advocacy
  2. Clinical trials landscape
  3. Red flags and safety concerns
  4. Patient-voice sources
  5. Open questions

Canonical wiki pages

File Scope Status
overview.md Condition map, evidence boundaries, stage-by-biology frame curated — audited
epidemiology-and-risk-factors.md Burden, smoking, never-smokers, pollution, susceptibility, equity draft — edited by 2026-10-16 sweep; awaiting audit
histology-and-classification.md IASLC/WHO, AIS/MIA, invasive patterns, grade, STAS, mucinous disease draft — edited by 2026-10-16 sweep; awaiting audit
screening-and-early-detection.md NLST/NELSON, eligibility, nodules, harms, never-smokers, blood/AI tests draft — edited by 2026-10-16 sweep; awaiting audit
staging.md TNM-9, work-up, multiple lesions, oligometastatic disease curated — audited
molecular-landscape.md Drivers, co-mutations, ancestry/exposure, evolution, spatial states curated — audited
molecular-testing.md Tissue stewardship, broad DNA/RNA, plasma, resistance, quality metrics curated — audited
egfr-disease.md IPASS, FLAURA/intensification, ADAURA, resistance, exon-20 disease draft — edited by 2026-10-30 sweep; awaiting audit
alk-ros1-and-fusion-drivers.md ALK, ROS1, RET, NTRK; CNS activity, sequencing, resistance draft — edited by 2026-10-30 sweep; awaiting audit
kras-braf-met-her2.md Allele-specific targeting, co-mutations, resistance, ADC/TKI strategy draft — edited by 2026-10-30 sweep; awaiting audit
immunotherapy.md PD-L1, mono/chemo-IO, driver interaction, resistance, toxicity draft — edited by 2026-10-30 sweep; awaiting audit
early-stage-and-perioperative-therapy.md Surgery, SABR, chemotherapy, adjuvant targeted therapy, perioperative IO, MRD draft — edited by 2026-10-30 sweep; awaiting audit
systemic-therapy.md Integrated first-/later-line routing and progression classification draft — edited by 2026-10-30 sweep; awaiting audit
biomarkers.md Genomic selectors, PD-L1, TMB, ctDNA/MRD, histology, multi-omics curated — audited
guidelines.md Cross-guideline synthesis, disagreements, version and jurisdiction hazards draft — version metadata edited 2026-10-30; awaiting audit
clinical-trials-landscape.md Live registry snapshot, active driver/MRD portfolios, design failure modes draft — edited by 2026-10-30 sweep; awaiting audit
patient-experience-and-advocacy.md Stigma, testing wait, chronic TKI life, caregivers, access, survivorship draft — edited by 2026-10-16 sweep; awaiting audit
red-flags-and-safety-concerns.md Emergencies, missed testing, TKI/ADC/IO toxicity, CNS vigilance curated — audited

The Pages table is the canonical filename list for link discipline. All 18 pages passed the 2026-08-29 audit; subsequent sweep edits leave 12 pages in draft pending a separate audit. The table above records current statuses.

Literature layer

Asset Purpose Status
BIBLIOGRAPHY.md 340 unique PubMed records, topic-grouped with citing pages/layers 270 audited; 70 sweep additions awaiting audit
Mok 2009 — IPASS Predictive-genotype turning point audited
TCGA 2014 Multiplatform molecular atlas audited
Soria 2018 — FLAURA First-line CNS-active EGFR backbone audited
Wu 2020 — ADAURA Adjuvant EGFR paradigm and OS audited
Forde 2022 — CheckMate 816 Neoadjuvant chemo-immunotherapy audited
Díaz-Gay 2025 — Sherlock-Lung Never-smoker genomic epidemiology audited
Guideline registry Worldwide/current sources, supersession, disagreements, watch list draft — 2026-10-16 additions, 2026-10-23 version/access recheck, and 2026-10-30 ASCO 2026.3.4 awaiting audit
Statistics ledger Effect sizes, denominators, methods, conflicts, reuse rules draft — rows added 2026-10-16, 2026-10-23, and 2026-10-30
Patient-voice README Method, ethics, coverage and update protocol audited
Organizations 12 live-fetched public organizations audited
Themes Aggregate themes with ≥2 sources each audited
Sources Annotated research and public-source ledger draft — 2026-10-16 studies/campaign and 2026-10-23 navigation material awaiting audit

Evidence architecture

  1. Adenocarcinoma-direct evidence: histology-specific molecular cohorts, driver-restricted trials, pathology studies.
  2. Mixed NSCLC evidence: screening, TNM, surgery, perioperative IO, stage III, brain metastases, supportive care.
  3. Mechanistic evidence: mutational signatures, organoids, spatial/single-cell atlases, resistance models.
  4. Guidance and registry state: living recommendations, authorizations, reimbursement, and trial status that require date-specific rechecking.

Highest-priority unresolved questions

  • Who needs first-line EGFR intensification?
  • Can ctDNA safely individualize adjuvant targeted or immune therapy?
  • Which lifetime ALK/ROS1/RET/HER2 sequence best prevents CNS failure?
  • Are STK11 and KEAP1 predictive or primarily prognostic?
  • Can never-smoker screening show mortality benefit without unacceptable overdiagnosis?
  • Is postoperative checkpoint therapy necessary after neoadjuvant response?
  • What improves survival after chemo-immunotherapy resistance?
  • How should chronic targeted-therapy survivorship and access be measured?

See OPEN-QUESTIONS.md for 30 study-shaped questions and the “Dots not yet connected” map.

Curation state

2026-10-30 sweep: Krascendo 1 (divarasib vs sotorasib/adagrasib, OS HR 0.56), KEYNOTE-867 (SBRT + pembrolizumab negative), two China-only post-EGFR ADCs (PANKU-Lung01, HERON-Lung01), PERSEE, R-ALPS, ELEVATE, HARMONi-A OS, and ASCO driver-alteration living guideline 2026.3.4 were incorporated. See LOG.md.

2026-10-16 sweep: FLAURA2 and MARIPOSA final overall-survival results (published before the build but missed by it), the ADAURA 8-year landmark, CROWN at 7 years, STARLET (randomized SRS deferral), HARMONi, the S1914 SABR + atezolizumab futility result, AEGEAN updated OS, and LAURA were incorporated; 11 pages were demoted to draft pending a different-engine audit. See LOG.md.

Full audit completed 2026-08-29. All 270 PMIDs used anywhere in the condition were re-queried live through PubMed E-utilities, all 42 NCT identifiers were re-fetched through ClinicalTrials.gov API v2, every page passed claim-to-citation and structural checks, and all 18 canonical pages are curated. See LOG.md for audit counts, corrections, limitations, and remaining dated evidence gaps.