Pancoast tumor, a special subtype of non-small cell lung cancer originating from the apex of the upper lobe, is characterized by its complex clinical manifestations and high treatment difficulty due to its unique anatomical location, often leading to a relatively poor prognosis. Currently, guidelines recommend neoadjuvant concurrent chemoradiotherapy followed by surgery as the standard treatment strategy, which has significantly improved overall patient survival compared to previous approaches. However, this regimen has limitations, including significant toxicity, increased surgical complexity, and a lack of individualized treatment options. In recent years, new strategies such as neoadjuvant targeted therapy and immune-chemotherapy combinations have shown higher pathological response rates and manageable safety profiles in clinical studies, offering new directions for treating Pancoast tumors. This case report describes a 56-year-old female diagnosed with stage ⅢC Pancoast tumor harboring co-mutations in EGFR and ERBB2 and high PD-L1 expression. Through dynamic biopsy-guided precise targeted therapy, a neoadjuvant strategy incorporating immunotherapy and chemotherapy, and successful surgical intervention, pathological complete response was achieved. This case highlights the critical value of a multidisciplinary team approach and precision medicine in the management of Pancoast tumor.