Lung cancer

Clinical / Scientific

Lung cancer comprises small-cell and non-small-cell histologies with distinct maps (EGFR, ALK, KRAS, ROS1, MET, RET, BRAF in NSCLC; RB1/TP53-loss neuroendocrine programmes in SCLC). Immune checkpoint biology is histology- and mutation-context-specific (e.g. KEAP1/STK11).

Molecular / histological subtypes

Core Biological Drivers

Oncogene-addicted RTKs/RAS

EGFR, ALK, ROS1, MET, RET, KRAS, BRAF subsets.

TP53 / RB1

Near-universal in SCLC; common in NSCLC.

KEAP1/NRF2

Antioxidant programme in a smoking-related subset.

Immune checkpoints

PD-L1 and T-cell exclusion vary widely.

Key Pathways

EGFR

Scientific explanation

EGFR is an ERBB-family tyrosine . Ligand activation or mutation (notably NSCLC exon 19/L858R) drives and signalling.

RAS/RAF

Scientific explanation

RAS GTPases and RAF kinases are frequent oncogenic nodes. KRAS, NRAS and BRAF mutations lock mitogenic signalling on in a ligand-independent way in many tumours.

MAPK/ERK

Scientific explanation

The RAS–RAF–MEK–ERK cascade transmits mitogenic RTK signals to programmes for proliferation and differentiation.

PI3K/AKT

Scientific explanation

phosphorylates PIP2 to PIP3, recruiting . supports growth, survival, glucose uptake and mTORC1 input. Pathway activation is common via PIK3CA mutation, PTEN loss or -tyrosine- signalling.

p53

Scientific explanation

TP53 encodes a stress-responsive factor controlling cell-cycle arrest, and metabolic adaptation. Loss or mutation is among the most common cancer events.

NRF2

Scientific explanation

NRF2/KEAP1 controls antioxidant and detoxification . KEAP1 or NFE2L2 mutations in lung and other cancers stabilize NRF2 and can confer therapy resilience.

PD-1 / PD-L1

Scientific explanation

PD-1 on T cells engaging PD-L1/PD-L2 restrains cytotoxic function. Tumour or myeloid PD-L1 is a canonical adaptive immune-evasion axis.

Glycolysis

Scientific explanation

Aerobic (Warburg metabolism) supports ATP, biomass and redox buffering even when oxygen is available. Hexokinase, PKM2 and lactate export are frequent nodes.

VEGF

Scientific explanation

family ligands drive endothelial sprouting and vascular permeability, a canonical tumour axis.

EMT

Scientific explanation

Epithelial–mesenchymal plasticity, driven by TWIST/SNAIL/ZEB and TGF-β/Wnt/Notch inputs, reduces adhesion and increases motility and stem-like features.

Pathway Convergence

Target → pathway → downstream effect → biological consequence. Shared intersections are mechanistic maps, not protocols.

Growth-factor signalling

Ligand or mutation-driven RTK input feeds PI3K/AKT and mTORC1, supporting anabolic growth. This is a map of signalling, not a treatment protocol.

Receptor tyrosine kinase
↓
PI3K/AKT
↓
mTOR
↓
Protein synthesis / growth

Hypoxia to vessels

Low oxygen stabilizes HIF-1α, inducing VEGF and endothelial sprouting. Anti-angiogenic pharmacology intersects this axis but does not erase the tumour ecosystem.

Hypoxia
↓
HIF-1α
↓
VEGF
↓
Angiogenesis

Mitochondrial stress

Electron-transport stress raises ROS; NRF2-driven transcription can buffer that stress and support survival. Antioxidant interventions are dual-edged.

Mitochondrial ROS
↓
NRF2 antioxidant programme
↓
Redox-buffered survival

Inflammatory survival

Chronic cytokine tone activates NF-κB and STAT3 transcriptional programmes that favour survival, invasion and sometimes immune evasion.

Cytokines
↓
NF-κB / STAT3
↓
Survival and invasion genes
↓
Therapy-tolerant phenotype

Metabolic Vulnerabilities

Aerobic supports ATP, biomass and acidification even when oxygen is available. Extent varies by tumour and remains a vulnerability hypothesis rather than a uniform target.

Glutamine anaplerosis and nucleotide nitrogen demand are prominent in MYC-high and rapidly proliferating tumours. Dependence is heterogeneous.

LKB1/STK11 loss couples metabolic and immune-cold phenotypes in KRAS-mutant disease.

Tumor Microenvironment

Disordered vasculature creates , HIF-1α stabilization, induction and immune-suppressive adenosine/lactate milieus.

Tumour-associated macrophages and myeloid-derived suppressor cells secrete cytokines that support invasion and blunt cytotoxic T cells.

Metastasis Module

, protease-mediated invasion, , circulating tumour-cell survival and organ-specific colonization form the metastatic cascade. Pre-metastatic niches and vascular permeability influence tropism.

Resistance Biology

Resistance can arise from drug efflux, secondary mutations, bypass RTK signalling, apoptotic threshold elevation, -mediated survival, metabolic adaptation and lineage plasticity.

Cancer Stemness

Wnt, Notch, Hedgehog, ALDH and CD44-associated programmes can mark stem-like fractions with quiescence and therapy tolerance. These markers are not interchangeable across tumour types.

Mechanism-Based Adjunctive Strategies

Compounds appear only where a mechanistic overlap exists for this cancer. Evidence tiers are not equivalent. Nothing here is a treatment recommendation.

Metformin

Clinical / Human EvidenceIn VivoIn VitroMechanistically Plausible

Target / Mechanism

Modest complex I inhibition raises AMP:ATP, activating and restraining hepatic and -linked anabolism. Direct antineoplastic efficacy is not established from that pharmacology alone.

Cancer relevance

activation and restraint provide a metabolic rationale in - and -linked tumours. Human data are mixed and do not establish metformin as cancer therapy.

Metabolic adjunctive research context. Convergence: AMPK, mTOR, Glycolysis.

Itraconazole

Early ClinicalIn VivoIn Vitro

Target / Mechanism

Azole antifungal; off-target reports include Hedgehog-pathway antagonism and anti-angiogenic endothelial effects in experimental and early clinical settings. Not a licensed antineoplastic.

Cancer relevance

Hedgehog antagonism and anti-angiogenic endothelial reports exist, including early clinical probes. Not a licensed antineoplastic.

Hedgehog / angiogenesis research. Convergence: Hedgehog, Angiogenesis.

Mebendazole

In VitroIn VivoMechanistically Plausible

Target / Mechanism

Benzimidazole that binds β-. Mammalian disruption, mitotic arrest and related signalling in cancer models are preclinical and are not an approved anticancer use.

Cancer relevance

disruption can trigger mitotic stress and in cell and animal models. This is not an established oncology use.

Experimental antimitotic / microtubule stress. Convergence: Apoptosis, p53.

Curcumin

In VitroMechanistically Plausible

Target / Mechanism

Polyphenol with promiscuous in-vitro NF-κB, and ROS effects. Bioavailability is poor; dish activity does not establish clinical anticancer efficacy.

Cancer relevance

In-vitro NF-κB/ effects are frequent. Poor bioavailability and absence of robust clinical anticancer efficacy keep this pathway-level.

Inflammatory-signalling dish models. Convergence: NF-κB, JAK/STAT.

Sulforaphane

In VitroIn VivoMechanistically Plausible

Target / Mechanism

Isothiocyanate that can activate NRF2 via KEAP1 modification and has epigenetic HDAC-related reports in models. Chemoprevention hypotheses exceed proven oncology treatment.

Cancer relevance

KEAP1/NRF2 activation and epigenetic reports in models. Chemoprevention hypotheses are not treatment proof.

NRF2 / chemoprevention research. Convergence: NRF2, Oxidative stress.

Statins (HMG-CoA reductase inhibitors)

Clinical / Human EvidenceIn VitroMechanistically Plausible

Target / Mechanism

Inhibit HMG-CoA reductase, depleting mevalonate-pathway isoprenoids needed for RAS/RHO prenylation and some sterol-dependent growth programmes. Observational oncology signals are mixed and not a licence to treat cancer with statins.

Cancer relevance

Mevalonate-pathway blockade can affect prenylation of RAS-family GTPases. Observational human signals are mixed and confounding is substantial.

Mevalonate / prenylation mechanistic overlap. Convergence: RAS/RAF, Fatty-acid metabolism.

EGCG

In VitroMechanistically Plausible

Target / Mechanism

Green-tea catechin with in-vitro effects on RTKs, epigenetic enzymes and redox. Clinical anticancer efficacy is not established.

Cancer relevance

Catechin effects on RTKs and redox in vitro. Clinical anticancer efficacy is not established.

RTK / redox dish models. Convergence: EGFR, PI3K/AKT.

Research Context

  1. EGFR NSCLC. Lynch TJ, et al. Activating mutations in the epidermal growth factor receptor underlying responsiveness of non-small-cell lung cancer to gefitinib. N Engl J Med. 2004;350(21):2129-2139. https://doi.org/10.1056/NEJMoa040938
  2. ALK. Soda M, et al. Identification of the transforming EML4-ALK fusion gene in non-small-cell lung cancer. Nature. 2007;448(7153):561-566. https://doi.org/10.1038/nature05945
  3. Hallmarks. Hanahan D, Weinberg RA. Hallmarks of cancer: the next generation. Cell. 2011;144(5):646-674. https://doi.org/10.1016/j.cell.2011.02.013
  4. Checkpoints. Pardoll DM. The blockade of immune checkpoints in cancer immunotherapy. Nat Rev Cancer. 2012;12(4):252-264. https://doi.org/10.1038/nrc3239

This oncology atlas is educational. Pathway maps, adjunctive strategies, and compound listings describe mechanistic relevance. They do not establish clinical efficacy, do not recommend treatment, and are not a substitute for oncology care. Evidence tiers are not equivalent.