Lung cancer, a leading cause of cancer-related mortality globally, presents complex challenges in treatment and disease management. This review explores β-elemene, a sesquiterpene from Curcuma wenyujin, emphasising its pharmacological effects and therapeutic mechanisms in lung cancer. Focusing on its roles in modulating cellular pathways, this study details β-elemene's influence on apoptosis, autophagy, ferroptosis, hypoxic responses, metabolic shifts, and cell cycle arrest, as well as its impact on the tumour microenvironment and regulatory pathways (including PI3K/AKT, STAT3, AMPK/MAPK) and non-coding RNAs. The potential of β-elemene as a complementary agent in chemotherapy, radiotherapy, and hyperthermia therapy is examined, underscoring its capability to bolster treatment efficacy and counter drug resistance. The review also addresses current obstacles in clinical use, notably bioavailability issues, and explores innovative delivery systems like liposomes and microemulsions designed to enhance therapeutic delivery. Although preclinical studies indicate significant anti-tumor effects, further research is needed to address clinical translation challenges. Collectively, this review highlights β-elemene's multi-targeted therapeutic potential in lung cancer, advocating for ongoing research to refine its clinical use and optimise patient outcomes.