Traditional Chinese Medicine for lung cancer: Mechanisms, clinical evidence, and future perspectives

Abstract Lung cancer remains a leading cause of global cancer mortality. Despite advances in conventional treatments such as surgery, chemotherapy, targeted therapy, and immunotherapy, challenges including drug resistance, toxicity, and cost persist. Traditional Chinese Medicine (TCM) offers a holistic, adjunctive approach centered on syndrome differentiation and the concept of “living with the tumor” to improve both disease outcomes and quality of life (QoL). This comprehensive review synthesizes preclinical and clinical evidence from cellular and animal studies, randomized controlled trials, observational cohorts, systematic reviews, and meta‐analyses. It examines TCM compounds' mechanisms of action, clinical efficacy, and integration challenges in lung cancer care. Preclinical studies demonstrate that TCM modalities‐including herbal formulas, acupuncture, and mind–body practices‐exert multi‐target effects by inducing programmed cell death (apoptosis, autophagy, ferroptosis, and pyroptosis), inhibiting angiogenesis and metastasis, and modulating immune responses through macrophage reprogramming and enhanced T‐cell/natural killer cell activity. Clinically, adjunctive TCM improves overall survival, progression‐free survival, symptom burden, and QoL, while reducing toxicity from chemotherapy and estimated glomerular filtration rate (EGFR) tyrosine kinase inhibitors. TCM also extends disease‐free survival postoperatively and shows synergistic potential with immune checkpoint inhibitors. TCM represents a promising complementary strategy in lung cancer management, supported by growing mechanistic and clinical evidence. However, integration faces challenges such as herbal variability, methodological limitations, and lack of biomarkers. Future progress depends on adopting systems biology, developing molecular‐targeted TCM compounds, conducting biomarker‐driven trials, and leveraging novel delivery systems. Regulatory harmonization and precision medicine frameworks will be essential to optimize TCM role in oncology.