Editorial: Editor’s challenge: Dr. Sara Pilotto - modulating tumor-host interplay through lifestyle in lung cancer

Lung cancer remains the most common malignancy worldwide, but its care is undergoing a profound revolution. Previously conceptualized as aberrant cellular proliferation, it is now increasingly understood as a systemic and dynamic disease shaped by interactions among the tumor microenvironment, host factors, treatment, and lifestyle features. Lifestyle interventions, and exercise in particular, are moving from the sole concept of supportive care to a biologically meaningful adjunctive strategy capable of influencing tumor-host dynamics. . Clinicians are increasingly recognizing that exercise in lung cancer simultaneously preserves everyday function-enabling patients to maintain functional capacity, independence, and the ability to manage daily activities at home. Prolonging the period of independent living is of substantial clinical relevance, and this Research Topic aims to drive a conceptual shift: lifestyle, and exercise in particular, is not merely a context for cancer care, but an active modifier of both disease trajectory and lived experience. A core theme emerging from this collection is the interplay between body composition and lung cancer. Historically, weight loss, sarcopenia, and cachexia have represented a hallmark in lung cancer, especially for the advanced disease, given their worse impact on patients' prognosis and treatment tolerance (1,2). Nevertheless, recently, the landscape has been further complicated by the metabolic consequences of modern treatments. Targeted agents, in particular, while extending survival, are associated with unintended weight gain and remodeling of adipose tissue, raising concerns regarding long-term prognosis, metabolic comorbidities, and quality of life (3). This emerging pattern provides a strong rationale for integrating exercise-based interventions, specifically targeting body composition to promote favorable increases in muscle mass, thereby improving long-term weight control. ( 4). Accordingly, one contribution to the present Research Topic presents a case in which structured exercise was successfully implemented to address lorlatinib-associated weight gain and unfavorable changes in body Taken together, this evidence provides a strong rationale for hypothesizing that exercise may affect clinical outcomes in cancer. This will no longer be a purely theoretical speculation. The randomized CHALLENGE trial in colon cancer demonstrated that a structured exercise program after adjuvant therapy improved disease-free survival and suggested an overall survival benefit (6). Focusing on lung cancer, some studies are ongoing across different disease phases and therapeutic contexts (7). Among these, the NAVIGATE study is evaluating whether the integration of structured exercise within a comprehensive supportive care strategy can affect 1-year overall survival in patients with non-small cell lung cancer. In parallel, the STARLighT project is exploring the impact of combined exercise and nutritional interventions in two settings: first, in patients undergoing neoadjuvant chemoimmunotherapy, with pathological complete response and quality of life as co-primary endpoints; and second, in the adjuvant setting, with disease-free survival as the primary endpoint (7). Complementing these efforts, the EXHALE study showed that supervised exercise during chemotherapy is feasible and clinically beneficial even in advanced lung cancer, including both small cell and non-small cell disease, with improvements in muscle strength and patient-reported outcomes (8,9).The growing body of evidence