Two years after Stanford physician Bryant Lin was diagnosed with Stage IV lung cancer, he is still teaching, traveling and attending San Francisco Giants games with his family. His treatment has moved from one targeted drug to another as the cancer changed — a personal example of advances that are beginning to alter care for some lung cancer patients, while leaving major gaps in access and affordability. Lin, a nonsmoker, helped establish Stanford’s Center for Asian Health Research and Education and has advocated for better lung cancer screening. He was diagnosed in May 2024, after years of working to improve awareness and research on the disease. “Super ironic that I would be co-leading the center that supports research and education in this disease, and I get diagnosed myself,” he said. Genetic testing can identify mutations that drive a patient’s cancer and help doctors select treatments aimed at those specific changes. UCLA oncologist and researcher Jonathan Goldman said such drugs can sometimes shrink or control tumors and often cause fewer side effects than less-targeted treatments. For some patients, he said, survival that once measured in less than a year can now extend for several years or longer. But access to the tests remains uneven. Goldman said fewer than half of U.S. lung cancer patients receive genetic testing before treatment, in part because it is not yet considered standard care everywhere and clinicians may not be familiar with rapidly changing options. He said testing early can help patients begin with the treatment best suited to their cancer. Lin initially took osimertinib, sold as Tagrisso, a daily targeted pill. About a year later, it stopped working. He then received a combination of amivantamab, an antibody treatment, and lazertinib, a pill targeting an EGFR mutation. Lin said the newer therapies have kept his symptoms controlled and enabled him to continue much of his daily life. The costs can be daunting, even for someone with Lin’s medical expertise and access to a major research hospital. Insurers may require prior authorization or decline to cover drugs that have not been incorporated into established treatment guidelines, he said. A $16,000 medication was delayed while he sought coverage. Some cancer drugs, he said, cost hundreds of thousands of dollars — sums few patients could pay themselves. The broader outlook remains difficult. The five-year survival rate across all stages of lung cancer is about 30%, though outcomes vary widely by stage; for localized disease, the rate was 67% for patients diagnosed from 2015 to 2021. Lin also continues to push for more screening: annual low-dose CT scans are recommended for people at high risk, but only about 18% of eligible patients are screened, according to the figures cited in his account. Researchers are studying whether tools such as artificial intelligence-assisted imaging, blood tests and personalized mRNA vaccines could improve detection or treatment. Lin said he has been investigating whether a custom mRNA vaccine might be an option for him. Such approaches remain under study; they are not established lung cancer treatments. Days after Lin discussed his care, scans showed his cancer had progressed. He was weighing another drug or a clinical trial. He described his approach as trying to stay alive long enough for the next treatment to arrive, while acknowledging that the odds remain against him. For now, he is also making time for family traditions and small pleasures, including Giants games with his wife and teenage sons. He has been writing on a seafoam-green manual typewriter as he works on a book about living while facing death.