Treatment outcomes for lung cancer — Korea’s most commonly diagnosed cancer and long considered one of the deadliest — are improving dramatically. According to the National Cancer Registry, the five-year survival rate for lung cancer in Korea reached 42.5 percent in 2019–2023, up 25.9 percentage points from 16.6 percent in 2001–2005.
Among all major cancers, lung cancer recorded the largest improvement in survival rates over that period. The reason is clear: patients gained access to innovative therapies such as targeted anticancer drugs and immunotherapies.
For lung cancer patients, survival often depends on whether they can receive new treatments. The same is true for small cell lung cancer (SCLC), which is known to have even worse outcomes than other forms of lung cancer.
A university hospital physician, identified only as Professor A, was diagnosed in September 2020 with extensive-stage small cell lung cancer (ES-SCLC), a condition widely regarded as terminal. Fortunately, beginning Aug. 1 of that year, the immunotherapy Tecentriq (atezolizumab) became reimbursable in Korea as a first-line treatment for ES-SCLC. Stable access to the drug allowed A to continue treatment and eventually return to work at her university hospital in 2023 after taking leave following her diagnosis.
Patients with ES-SCLC typically survive only six to eight months on average. But because A’s tumor expressed PD-L1, she was eligible for immunotherapy and was able to live nearly five years in relatively good health despite cancer spreading to the pleura.
The situation changed again last year. Although immunotherapy had kept her cancer under control and significantly reduced the tumor burden, the lung cancer began progressing and eventually metastasized to her spine. A discovered this on Aug. 15 last year after suddenly losing strength in one leg and undergoing a spinal MRI.
A chest CT scan performed two months earlier had shown no signs of tumor growth. But after spinal metastasis was identified, a repeat CT revealed that the lung cancer had enlarged.
After surgery to remove the spinal metastatic tumor, A switched to Zepzelca (lurbinectedin), a cytotoxic chemotherapy agent. However, severe bone marrow suppression developed as a side effect. Her white blood cell count dropped to around 200 cells per microliter — far below the normal minimum of 4,000 — and she subsequently developed pneumonia.
The once-healthy professor deteriorated rapidly within about a month. After Tecentriq and Zepzelca, there were effectively no meaningful treatment options available for SCLC patients in Korea at the time.
Imdelltra (tarlatamab), a bispecific T-cell engager (BiTE) therapy approved in the United States as a second-line treatment for SCLC, had already received approval in Korea in May 2025 as a third-line therapy. However, because the drug price had not yet been finalized, it remained unavailable for clinical use in Korea.
At the time, A’s condition had worsened so severely that she required mechanical ventilation due to inadequate oxygen supply. A refused life-prolonging treatment, saying she “wanted to go peacefully.”
By mid-September, her condition deteriorated further, and family members were called in for what was believed to be a final farewell.
Professor Hwang Won-min of Konyang University Hospital, whose wife is battling small cell lung cancer, called for the swift reimbursement approval of Imdelltra. (Korea Biomedical Review with Google Gemini)
At that desperate moment, her husband -- Professor Hwang Won-min of the Department of Nephrology at Konyang University Hospital -- became determined to somehow obtain Imdelltra for his wife. He believed that if she could receive the drug and respond as reported in clinical studies, she might regain her former life.
Hwang contacted acquaintances in the United States, Japan and elsewhere in search of ways to obtain the drug. During the process, he learned that Imdelltra’s price in Korea had finally been determined and that the drug would soon become available as a non-reimbursed treatment. He also discovered that Samsung Medical Center and Konyang University Hospital could begin administering the therapy as early as October.
As chairman of Konyang University Hospital’s pharmacy committee, Hwang then opened an email he had overlooked amid the chaos.
The agenda included a list of drugs pending review — and, almost miraculously, Imdelltra was among them.
Hwang immediately convened the pharmacy committee, enabling the hospital to rapidly introduce Imdelltra. On Oct. 2 last year, A became the first patient in Korea to officially receive Imdelltra.
The results were dramatic. Changes were already visible on X-ray images taken just three to four days after the first dose.
“We barely managed to secure Imdelltra right before the long Chuseok holiday, so we couldn’t even think about performing a chest CT scan,” Hwang said. “Instead, we checked an X-ray to evaluate the response, and even on the X-ray alone, it was obvious that my wife’s lung cancer had improved. A week later, another X-ray showed further improvement.”
“Three weeks later, after completing one treatment cycle, a chest CT scan showed that the tumors had already shrunk by more than half. My wife, who previously couldn’t even take a single step away from the bed, improved enough to be discharged in the third week of October,” he added.
More than six months later, A is now living a healthy daily life again — unimaginable for someone who had been near death in September last year.
“So far, my wife has received 14 doses of Imdelltra,” Hwang said. “These days, she hikes Oknyeobong Peak on Mt. Cheonggye in southern Seoul. When we visited Seoul Forest in late October last year, she struggled just to walk from the parking lot to the entrance while holding onto me. But she gradually improved, and now she has recovered enough to carry out normal daily activities without difficulty.”
According to Hwang, other SCLC patients could also regain healthy lives through Imdelltra. The problem is access.
Each administration costs about 22.6 million won ($15,408), leaving very few Korean patients able to receive the treatment.
“As far as I know, only about 12 lung cancer patients in Korea are currently receiving Imdelltra,” Hwang said. “It’s not just my wife who responded well. Imdelltra demonstrated efficacy in numerous patients through phase 3 clinical trials, but Korean lung cancer patients are being deprived of treatment opportunities.”
Lung cancer remains Korea’s most common cancer, with roughly 30,000 new cases diagnosed annually. Small cell lung cancer accounts for 10–15 percent of cases, meaning at least 3,000 patients are newly diagnosed with SCLC every year.
Moreover, most SCLC patients have extensive-stage disease characterized by rapid progression and high recurrence risk. Yet only slightly more than 10 patients in Korea are currently receiving Imdelltra, highlighting the severe limitations in access to breakthrough therapies.
Amgen Korea is aware of the situation and has already filed for reimbursement coverage with the Health Insurance Review and Assessment Service (HIRA). But for patients and their families, waiting calmly is not an option.
Families currently paying for the treatment are also struggling financially. Hwang said he sold the family home where he had lived with his wife and son and moved into a smaller residence near the hospital.
“I was terrified thinking about what would happen if we didn’t have money for next month’s treatment,” he said. “In the end, we had no choice but to sell our house.”
Even selling a home does not guarantee long-term access to treatment. Just as reimbursement for Tagrisso (osimertinib) and Leclaza (lazertinib) established a stable treatment environment for non-small cell lung cancer (NSCLC), SCLC patients also need a system that guarantees stable access to Imdelltra.
“Imdelltra is truly a highly effective drug,” Hwang said. “More SCLC patients need to be able to receive treatment consistently and safely. Reimbursement for Imdelltra is urgently needed.”
Kim Kyoung-Won
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