South Florida is becoming a crucial region for progress in lung cancer care, according to Bruna Pellini, MD, chief of Thoracic Oncology at Baptist Health Miami Cancer Institute. In Dr Pellini on Lung Cancer Disparities and Innovation she stresses that the region’s demographics — in particular a large group of younger patients and a high concentration of people of Hispanic background — make it all the more important to keep up with recent drug approvals and with the rapidly evolving genomic research shaping thoracic oncology.
The changing picture of lung cancer — and why stigma still plays a role
Pellini notes that patients of Hispanic background often have a higher incidence of certain genomic alterations in their tumour. She also sees that many patients found to have rare genomic drivers are women — a development that challenges the persistent stereotype of who a “typical” lung cancer patient is. As she puts it: if you have lungs, you can get lung cancer. That message is central to Dr Pellini on Lung Cancer Disparities and Innovation, and underlines the need not to let lung cancer stigma rest so heavily on smoking history.
Screening gaps among “non-traditional” patients
Despite the advances in modern oncology, Pellini points to a significant barrier: current lung cancer screening guidelines often do not include never-smokers, which leaves many people at risk without a clear pathway to early detection. With growing media attention and research into screening for these patients, she argues in Dr Pellini on Lung Cancer Disparities and Innovation that recommendations need to evolve so that people currently falling outside them are no longer missed.
From limited options to accelerating innovation
Pellini reflects on how much thoracic oncology has changed. Two decades ago, she says, many doctors did not choose this field because there were few effective treatments. In 2026 the opposite is true: lung cancer care is becoming increasingly complex, with frequent new approvals and a growing role for genomics. As a member of the ASCO guidelines for non-small cell lung cancer (NSCLC) and of the Scientific Program Committee for stage IV NSCLC, she remains closely involved in that evolution — as described in Dr Pellini on Lung Cancer Disparities and Innovation. She adds that her clinical practice often attracts the rarest and most complex cases, which she links to her focus on genomic alterations and her rapport with female patients. She expects Baptist Health to remain a hub for these specialised cases, and so to be able to offer highly personalised care to the diverse community of South Florida.
New frontiers in rare, targetable NSCLC alterations
Alongside these demographic and screening challenges, Pellini highlights what she describes as an unprecedented period of progress for patients with rare genomic subtypes of NSCLC. In New Frontiers in Targeted Therapy for Rare Lung Cancer Alterations she recalls that only a few years ago thoracic oncologists did not have access to the highly effective targeted options that were already more common in other cancers, such as breast cancer. Today, she says, that gap has narrowed — certainly in HER2-mutant and ROS1-positive disease.
The HER2 revolution in lung cancer
In New Frontiers in Targeted Therapy for Rare Lung Cancer Alterations, Pellini explains that HER2 mutations in lung cancer historically had few effective, mutation-specific therapies, but that recent approvals have redrawn the standard of care. She points to three approved agents that have considerably expanded the options for this group.
- Trastuzumab deruxtecan (T-DXd; Enhertu), an antibody-drug conjugate with substantial activity in HER2-mutant lung cancer, as cited in New Frontiers in Targeted Therapy for Rare Lung Cancer Alterations.
- Zongertinib (Hernexeos), a potent HER2-directed therapy which, according to New Frontiers in Targeted Therapy for Rare Lung Cancer Alterations, was approved in August 2025 and has a far more tolerable toxicity profile than earlier attempts to target HER2.
- Sevabertinib (Hyrnuo), which according to New Frontiers in Targeted Therapy for Rare Lung Cancer Alterations was approved in late 2025, adding a further important option for patients who previously had few alternatives.
Progress in ROS1- and ALK-positive disease
For ROS1-positive NSCLC, Pellini highlights in New Frontiers in Targeted Therapy for Rare Lung Cancer Alterations taletrectinib (Ibtrozi), approved in the summer of 2025, as a meaningful step forward — particularly because it addresses central nervous system (CNS) toxicities seen with older ROS1 inhibitors, including chronic dizziness and an increased risk of falls. She explains there that taletrectinib not only delivers high response rates and shrinks tumours in the brain effectively, but does so without the debilitating dizziness that troubles many patients.
In the same contribution, New Frontiers in Targeted Therapy for Rare Lung Cancer Alterations, she refers to “fascinating” findings from the CROWN study of lorlatinib (Lorbrena) in ALK-positive NSCLC: the results showed a five-year median progression-free survival (PFS) that had not yet been reached, something she says would previously have been unthinkable in stage IV lung cancer. She says these data have changed her own practice, making lorlatinib a preferred first-line choice.
Precision also means: the right approach for the right patient
Even with the strong advance of targeted pills, Pellini stresses in New Frontiers in Targeted Therapy for Rare Lung Cancer Alterations that optimal care does not always equate to targeted therapy. She refers to research published in 2025 suggesting that, for certain subgroups — such as those with BRAF mutations or MET exon 14 skipping mutations — chemotherapy plus immunotherapy may deliver better survival outcomes than targeted therapy alone. She frames making these increasingly nuanced choices as a core challenge in modern thoracic oncology: ensuring “the correct therapy for the correct patient”.