Therapeutic Bronchoscopic Intratumoral Injection in Lung Cancer: Current Advances, Challenges, and Opportunities for Resource-Limited Settings

Abstract

Lung cancer remains the leading cause of cancer-related deaths globally, with a high burden in Southeast Asia, including Indonesia. Conventional treatments, including surgery, radiotherapy, and systemic chemotherapy, are often limited by patient factors such as multifocal disease, poor pulmonary reserve, or central airway obstruction. This review explores bronchoscopic intratumoral injection as a novel, localized therapeutic strategy and assesses its feasibility in resource-limited settings. We conducted a narrative synthesis of recent literature on bronchoscopic intratumoral injection techniques, therapeutic agents, clinical outcomes, and implementation challenges. Additional focus was placed on the Indonesian healthcare context, particularly the infrastructure in West Sumatra. Bronchoscopic intratumoral injection delivers chemotherapeutic, immunologic, or gene-based agents directly into tumors using flexible bronchoscopy, including transbronchial needle injection, endobronchial ultrasound-guided injection, and cone-beam computed tomography. This approach achieves high local drug concentrations with minimal systemic toxicity, shifting the paradigm toward immune modulation and durable tumor control. Clinical outcomes include improved airway patency, lung function, symptom relief, and survival in patients ineligible for standard therapies. Feasibility in Indonesia is supported by existing clinical resources and agent availability. Despite challenges, such as limited access to advanced imaging, specialized equipment, and skilled personnel, bronchoscopic intratumoral injection may represent a promising investigational strategy in selected cases. Further research is warranted before routine clinical implementation can be contemplated. Strategies such as structured training and regional collaboration can bridge implementation gaps, aligning innovation with equitable lung cancer care in developing countries.