Welcome to the October 2025 BTOG trainee newsletter, where we aim to provide you with updates relevant to trainees working in the thoracic oncology space. In terms of content, the trainee newsletter will seek to summarise the ‘hot-off-the-press’ landmark papers, list updates for trainee-led multicentre projects, and sign-post readers to useful educational/professional content.
Your BTOG trainee representatives:
- Michiala Cafferkey – Respiratory
- Paolo Davide d’Arienzo – Medical Oncology
- Kishen Patel – Clinical Oncology
- Tanya Patrick – Respiratory
You can contact the BTOG Trainee Representatives by email using info@btog.org
Clinical Oncology
Durvalumab after sequential chemoradiotherapy in unresectable stage III non-small-cell lung cancer-final analysis from the phase II PACIFIC-6 trial
The current standard of care for fit patients with unresectable stage 3 non-small-cell lung cancer (NSCLC) is platinum-based concurrent chemoradiotherapy (cCRT) followed by consolidation durvalumab. This regimen received global approvals based on the results of the phase III PACIFIC trial (NCT02125461)(1), which showed significant improvement in overall survival.
Although cCRT is generally preferred over sequential chemoradiotherapy (sCRT), with meta-analysis confirming superior survival (2), many patients are not eligible for cCRT in routine practice. Contributing factors include poor fitness, large volume of disease and increased risk of treatment-related toxicity with cCRT. In particular elderly, frail or comorbid patients may not be able to tolerate cCRT. Practical barriers such as delayed access to radiotherapy facilities can also influence treatment decisions.
The use of consolidation durvalumab after sequential chemoradiotherapy is controversial. While both the EMA and FDA approvals did not restrict durvalumab use to a specific chemoradiotherapy sequence, NICE authorised it only following cCRT (3). As such, clinical practice has been primarily guided by data from the cCRT setting, with limited prospective evidence supporting use after sCRT.
PACIFIC-6 Trial Overview
PACIFIC-6 was a multi-centre, open-label, single-arm, phase II trial designed to evaluate the safety and efficacy of durvalumab following sCRT. Eligible patients were age ≥18 years with histologically or cytologically confirmed, unresectable stage III NSCLC, PS 0-2, and no disease progression after completing platinum-based sCRT. Key exclusion criteria included mixed small-cell and NSCLC histology, prior receipt of cCRT, receipt of sCRT with two or more concomitant cycles of chemotherapy and radiotherapy, and unresolved grade ≥2 toxicities from sCRT.
Chemotherapy regimens were histology-driven and included agents such as etoposide, gemcitabine, pemetrexed, taxanes, vinblastine, or vinorelbine, in accordance with local protocols. Radiotherapy followed within 6 weeks, at a dose of 60 Gy +/- 10%, and adhered to institutional and quality assurance protocols.
Following sCRT, patients received durvalumab 1500 mg intravenously every 4 weeks for up to 24 months or until disease progression, unacceptable toxicity, alternative therapy initiation, or withdrawal of consent. The sequencing of chemotherapy and radiotherapy reflected the heterogeneity of real-world clinical practice.
The primary endpoint was measuring the incidence of grade 3/4 pneumonitis-related adverse events (PRAEs) within 6 months of starting durvalumab. Secondary endpoints included progression-free survival (PFS) and overall survival (OS).
Key findings:
Between April 2019 and December 2020. 117 patients were enrolled across 25 centres in six countries. Median follow-up was 32.6 months.
The study population reflected real-world diversity: 65.8% were aged ≥65 years and 31% had a PDL1 expression <1%, Although treatment choice (sCRT vs. cCRT) was at the investigator discretion, the rationale was not recorded, limiting insights into selection bias.
The final analysis confirmed both safety and efficacy of consolidation Durvalumab after sCRT.
Efficacy: Median OS was 39.0 months, with a 3-year OS rate of 56.5%. Median progression-free survival PFS was 13.1 months, and the 2-year PFS rate was 35.3%.
Safety: Grade 3/4 treatment-related AEs occurred in 6.0% of patients, including pneumonitis in 1.7%. Similarly, 6.0% experienced grade 3/4 pneumonitis-related adverse events (PRAEs). Three patients (2.6%) experienced fatal adverse events (AEs), one of which was a fatal PRAE. Discontinuation of durvalumab due to AEs occurred in 27.4% of patients.
These results confirm that durvalumab following sCRT is both feasible and effective, offering a valuable alternative for patients who are not suitable candidates for cCRT due to age, frailty, or comorbidity.
Looking Ahead: PACIFIC-5
Building on PACIFIC-6, the phase III PACIFIC-5 trial further evaluated durvalumab following either cCRT or sCRT in patients with unresectable stage III NSCLC and no progression after definitive, platinum-based chemoradiotherapy. The study enrolled a predominantly Asian population and randomised patients 2:1, stratified by tumour PD-L1 expression. Results presented at ESMO Asia 2024 (4) showed that PACIFIC-5 met its primary endpoint, with a significant improvement in PFS after both cCRT and sCRT. Overall survival data are maturing, with follow-up ongoing.
Implications for UK Clinical Practice
While PACIFIC-6 and PACIFIC-5 provide valuable prospective evidence supporting the safety and efficacy of durvalumab following sequential chemoradiotherapy (sCRT), their immediate impact on UK clinical practice remains limited. This is primarily because NICE currently restricts durvalumab reimbursement to patients who have received concurrent chemoradiotherapy (cCRT), as defined in TA798 (3).
Therefore, until the full results from PACIFIC-5, including mature overall survival data, are published and NICE guidance is formally revised, the routine use of durvalumab following sCRT in the UK is unlikely to change.
A similar consideration applies to the use of durvalumab following radiotherapy alone in patients unfit for any chemotherapy, in light of the DUART trial, presented at ESMO 2023 (5) (but still unpublished). While this study provides encouraging data in a previously under-served population, implementation into UK practice will again depend on regulatory review and health technology assessment by NICE.
In summary, PACIFIC-6, PACIFIC-5, and DUART represent important steps toward broadening the evidence base for consolidation immunotherapy in more diverse and frail patient populations. However, translating these findings into routine practice in the UK will require a shift in national guidance, aligned with the evolving evidence base.
- Spigel DR, Faivre-Finn C, Gray JE, Vicente D, Planchard D, Paz-Ares L, et al. Five-year survival outcomes from the PACIFIC trial: durvalumab after chemoradiotherapy in stage III non–small-cell lung cancer. Journal of Clinical Oncology. 2022;40(12):1301-11.
- Auperin A, Le Pechoux C, Pignon J, Koning C, Jeremic B, Clamon G, et al. Concomitant radio-chemotherapy based on platin compounds in patients with locally advanced non-small cell lung cancer (NSCLC): a meta-analysis of individual data from 1764 patients. Annals of oncology. 2006;17(3):473-83.
- NICE. Durvalumab for maintenance treatment of unresectable non-small-cell lung cancer after platinum-based chemoradiation 2022 [Available from: https://www.nice.org.uk/guidance/ta798.
- Wu Y, Wu L, Bi N, Cil T, Ge H, Zhu Z, et al. LBA6 PACIFIC-5: A phase III study of consolidation durvalumab (D) in patients (pts) with unresectable stage III NSCLC and no progression after concurrent or sequential chemoradiotherapy (cCRT or sCRT). Annals of Oncology. 2024;35:S1624.
- Filippi A, García-Campelo M, Paoli J, Kowalski D, Bennati C, Borghetti P, et al. LBA62 Durvalumab after radiotherapy (RT) in patients with unresectable stage III NSCLC ineligible for chemotherapy (CT): Primary results from the DUART study. Annals of Oncology. 2023;34:S1302.
Corinne Faivre-Finnn
Professor of Thoracic Radiology Oncology at the University of Manchester and Honorary Consultant Clinical Oncologist, The Christie Hospital
Member of the BTOG Board of Trustees
Medical Oncology
IMforte: atezolizumab plus lurbinectedin as first-line maintenance treatment in patients with extensive-stage small cell lung cancer
Image from Wikimedia Commons used under a CC BY-SA 3.0 License.
IMforte is a randomised, multicentre, open-label, phase III clinical trial that investigated the combination of lurbinectedin and atezolizumab as maintenance therapy after induction platinum/etoposide/atezolizumab for patients with treatment naive extensive-stage small-cell lung cancer (ES-SCLC).
Lurbinectedin is a synthetic, marine-derived chemotherapeutic agent which exerts cytotoxic effects via multiple mechanisms. Lurbinectedin binds one DNA helix covalently and the other noncovalently, leading to inhibition of RNA transcription and formation of DNA breaks. In particular, its main targets are CG-rich regions within promoter regions, thus disrupting the action of transcription factors to which SCLC cells are addicted (i.e. ASCL1, NEURO-D1), ultimately leading to cell death. Lurbinectedin was shown to alter the tumour microenvironment and to synergise with immune checkpoint blockade in animal studies; the proposed mechanism involves the release of damage-associated molecular patterns due to cancer cell death, which subsequently enhances the recruitment of immune cells within the tumour.
Lurbinectedin was approved by the FDA for treatment of ES-SCLC after progression on or after platinum-based chemotherapy, but it is not currently approved by EMA.
The IMforte investigators argue that (i) optimising first-line treatment strategies is an critical clinical priority as a high proportion of patients will not proceed to second-line therapy upon progression (~50% in both arms of IMpower133); (ii) the maintenance phase is a relevant time point for treatment escalation, as most patients exhibit tumour response during induction treatment, but many experience disease progression shortly afterwards. Lurbinectedin plus anti-PD-(L)1 blockade showed promising activity in the platinum-experienced/checkpoint inhibitor-naïve setting in two phase I/II trials (2SMALL and LUPER; ORR ~50%, mPFS ~ 5 months).
In IMforte, patients with untreated ES-SCLC entered the trial at the time of commencing induction treatment and underwent re-screening and randomisation upon completion of four cycles of carboplatin, etoposide, and atezolizumab.
Per protocol, disease control and lack of CNS spread had to be demonstrated prior to randomisation. Prophylactic cranial irradiation was permitted, with provisions made for delay in commencing maintenance therapy in this patient subgroup. Measurable disease was mandated at trial entry but not upon completion of induction therapy. At this point, patients were randomised to receive lurbinectedin plus atezolizumab or atezolizumab alone, both administered intravenously three-weekly until progression or unacceptable toxicity. G-CSF prophylaxis was mandated in the experimental arm. Crossover was not permitted.
The two co-primary endpoints were progression-free survival as assessed by an independent review facility (IRF-PFS), and overall survival. Both survival endpoints were calculated from randomisation, i.e. from commencement of maintenance therapy.
Median follow-up was 15.0 months. Baseline characteristics were generally well-balanced across treatment groups, with the one notable exception of age (51% vs. 63% of randomised patients were aged 65 or over in the experimental arm and control arm, respectively).
Both IRF-PFS and OS were improved in the lurbinectedin plus atezolizumab arm compared with the control arm. Median IRF-PFS was 5.4 and 2.1 months, respectively (HR 0.54, 95% CI 0.43 – 0.67). Median OS was 13.2 and 10.6 months, respectively (HR 0.73, 95% CI 0.57 – 0.95). At the 12-month mark, the PFS rate was 20.5% in the combination arm and 12.0% in the control arm; for OS, these rates were 56.3% and 44.1%, respectively. Subgroup analyses showed consistent benefit across predefined groups, except for patients who underwent prophylactic cranial irradiation and patients with elevated LDH at the time of commencing maintenance therapy, for whom there was no clear OS benefit from combination therapy.
Treatment-related adverse events (TRAEs) occurred in 83% and 40% of patients in the lurbinectedin plus atezolizumab and atezolizumab monotherapy arms, respectively. The rate of grade ³3 TRAEs was 26% and 6%, respectively. The most common lurbinectedin-associated TRAEs were cytopenias (anaemia, 32% of patients in combination arm; neutropenia, 13%; thrombocytopenia, 13%), nausea (36%), vomiting (14%), diarrhoea (13%), and infections with (4%) or without (36%) concomitant neutropenia. Combination therapy did not increase the rate of toxicities usually associated with atezolizumab, except for hepatitis (any grade, 10% vs. 6%; grade 3, 4% vs. 1%). The treatment related discontinuation rate for lurbinectedin was 5%.
IMforte is the first phase III study to show an improvement in survival outcomes with combination therapy in the maintenance phase for first-line anti-cancer therapy for ES-SCLC. Where available, it should be considered as a new treatment option for patients with ES-SCLC with favourable outcome after completion of induction therapy.
The median PFS observed in the lurbinectedin plus atezolizumab arm in IMforte was similar to what reported in 2SMALL and LUPER, in which lurbinectedin plus anti-PD-(L)1 therapy was used upon disease relapse rather than immediately after induction therapy. However, 55% of patients in the IMforte control arm who discontinued treatment did not receive subsequent anti-cancer therapy, confirming that (i) high attrition on progression is a significant issue in ES-SCLC, and (ii) optimisation of first-line treatment is a potential strategy to provide clinical benefit to as many patients as possible.
Most patients in the IMforte combination arm eventually experienced disease progression; the OS curves remain well separated at this time, but follow-up is too short at present to reveal whether combination therapy led to long-term remission in a subset of patients.
While adding in lurbinectedin in the maintenance phase resulted in improved PFS and OS in IMforte, this approach results in (i) ongoing requirement for intravenous therapy after completion of induction therapy, while atezolizumab monotherapy can be administered subcutaneously, and (ii) ongoing cytotoxic chemotherapy-related toxicities, both of which need to be taken into account when discussion treatment options.
The IMFORTE trial demonstrated that, for patients with treatment naive extensive-stage small-cell lung cancer (ES-SCLC), the combination of lurbinectedin and atezolizumab given as maintenance therapy after induction platinum/etoposide/atezolizumab led to improved PFS and OS when compared to atezolizumab alone.
There was a higher incidence of adverse events in the lurbinectedin/atezolizumab arm, mostly driven by haematological and GI toxicity and this, together with the need for IV administration of lurbinectedin, needs to be considered when discussing this strategy with our patients.
The results of this trial are biologically plausible given the potential synergistic effect of lurbinectedin and atezolizumab as demonstrated in preclinical studies and in LUPER and 2SMALL trials.
It is important to point out that, differently than IMPOWER 133, patients were randomised after the induction phase and therefore this study selected only patients whose disease was controlled after 4 cycles of chemo-immunotherapy.
Due to study design, PFS and OS were calculated from initiation of maintenance, making efficacy comparison with IMPOWER133 difficult. Longer follow up may clarify if there is a maintained separation of the survival curves at 3 and 5 years.
Overall, IMFORTE is an important step forward in the first-line treatment for ES SCLC. Intensification maintenance strategies are crucial for this disease as more than 50% of the patients may not be fit enough to receive second-line therapies.
Raffaele Califano
Honorary Professor of Thoracic Oncology at the University of Manchester and Consultant Medical Oncologist, The Christie Hospital
Respiratory
VERITAS
Navigational Bronchoscopy or Transthoracic Needle Biopsy for Lung Nodules
Image credit Cancer Research UK used under a CC BY-SA 4.0 license
Pulmonary nodules are commonly identified either incidentally or on lung cancer screening low-dose CT. Nodule biopsy can determine a definitive diagnosis. BTS guidance recommends consideration of biopsy based on a combination of nodule size, type, risk score (Brock/Herder) and growth rate. CT-guided transthoracic needle biopsy and navigational bronchoscopy are two potential approaches for sampling peripheral lung nodules. CT-guided needle biopsy uses intraprocedural CT images to guide positioning of a biopsy needle that is passed through the chest wall and pleura. Navigational bronchoscopy uses electromagnetic fields to produce a GPS-like map of the airways, including live bronchoscope and lesion position. More recent technology produces 3D images using digital tomosynthesis and cone beam CT during navigational bronchoscopy that can account for differences in position of the lesion on pre-procedure CT and at the time of the procedure (‘CT scan-body divergence’). Although diagnostic accuracy has reportedly improved with this newer technology, randomised trial comparisons of navigational bronchoscopy and CT-guided needle biopsy were lacking.
Therefore, in a recent New England Journal of Medicine article, Lentz et al investigated the effect of navigational bronchoscopy and transthoracic needle biopsy on diagnostic accuracy. VERITAS was a multicentre, non-inferiority trial that randomised patients with intermediate or high-risk peripheral nodules (≥ 10% risk of malignancy according to Brock or Herder models) between 10mm and 30mm in diameter to navigational bronchoscopy or transthoracic needle biopsy. The primary outcome was diagnostic accuracy, defined as the percentage of patients with biopsies showing a specific diagnosis that was confirmed to be correct after 12 months of follow up. Secondary outcomes included complication rates and procedure duration. Bronchoscopies were performed under general anaesthesia, using a navigation platform, radial EBUS and rapid onsite cytological assessment. Moderate sedation or general anaesthesia was used for the CT-guided biopsies.
129 patients were randomised to each procedure. After excluding those lost to follow up, there were 119 patients in the navigational bronchoscopy group and 110 in the transthoracic needle biopsy group. Diagnostic accuracy was achieved in 79% (94/119) of the navigational bronchoscopy group and 74% (81/110) of the transthoracic needle biopsy group (absolute difference 5.4%; 95% CI -6.5 to 17.2; p=0.003 for non-inferiority; p=0.17 for superiority).
Overall complications rates were lower in the in the navigational bronchoscopy group compared to the CT-guided biopsy group (5% (2/121) vs 29.2% (22/113) (absolute difference 24.2% (95% CI 15.0 to 35.6); p<0.001)). Pneumothorax rates were also lower in the navigational bronchoscopy group (3.3% (4/121) vs 28.3% (32/113) (absolute difference 25% (95% CI 15.3 – 34.8); p<0.001)), including those leading to chest drain insertion and/or hospital admission (0.8% (1/121) vs 11.5% (13/113) (10.7% absolute difference (95% CI 3.7-17.6); p<0.001)).
A further interventional procedure was required for approximately 13% of individuals from each group (navigational bronchoscopy: 16 (13.2%) vs needle biopsy 15 (13.3%); absolute difference 0.1 (95% CI −8.8 to 8.7)). 3.6% (4/110) of participants in the needle biopsy group had nodules that were subsequently reclassified as malignant, but there were none of these in the navigational bronchoscopy group.
Median procedure duration was 36 minutes (IQR 28-48 minutes) for navigational bronchoscopy and 25 minutes (IQR 13-36 minutes) for transthoracic needle biopsy, with a median difference of 11 minutes (95% CI 8-18).
The authors conclude that the diagnostic accuracy of navigational bronchoscopy was non-inferior to transthoracic needle biopsy and had fewer complications. Therefore, for individuals with indeterminate nodules amenable to both approaches, they suggest that navigational bronchoscopy should be the procedure of choice.
This multicentre, randomized noninferiority trial is a valuable contribution to the literature, comparing the diagnostic yield and complications of biopsy using navigational bronchoscopy versus percutaneous CT-guided biopsy. The authors conclude that navigational bronchoscopy should be the procedure of choice for biopsying indeterminate lung nodules that are technically amenable to biopsy via either method. As navigational bronchoscopy is non-inferior to CT guided lung biopsy in terms of diagnostic accuracy, this recommendation is based on the reported complication rate associated with CT biopsy, primarily pneumothorax and chest drain insertion rates. The authors report a chest drain insertion rate of 11.5% for the CT-guided biopsy group and 0.8% in the navigational bronchoscopy group.
These findings warrant some scrutiny. Pneumothorax that does not require admission or chest drain insertion is a minor grade 1 common terminology criteria for adverse events (CTCAE) complication. Two previous meta-analyses have reported substantially lower chest drain insertion rates after CT guided lung biopsy (1.3% and 5.6%) (1,2) raising questions about why the rate in the current study is so high. Unusually, the protocol in this randomized trial required the CT arm to undergo biopsy under general anaesthesia or with deep sedation. It is possible that the elevated pneumothorax and chest drain insertion rates could be linked to positive pressure ventilation during general anaesthesia, excessive (or poorly controlled) respiratory motion as a result of sedation, or the operator’s preference to place a chest drain while the patient is sedated or asleep, rather than adopting a more conservative watch-and-wait approach.
One notable and significant omission from this study is a cost-effectiveness comparison. A 2024 analysis of the cost of disposable instruments for both procedures at our institution found the cost of CT-guided biopsy (£36 per case) to be approximately 1/60th of the cost of navigational bronchoscopy (in excess of £2130 per case). Additionally, the cost of anaesthesia (including staff, medications, and equipment) for navigational bronchoscopy further augments the overall expense. In a resource-constrained healthcare system like the national health service (NHS), where the two procedures have comparable diagnostic accuracy, the significantly higher cost of bronchoscopic biopsy makes it difficult to justify for routine care based solely upon a complication – CT drain insertion – which more likely occurs in approximately 1 in 20 cases of CT biopsy. CT guided lung biopsy is a well-established option and should remain the standard of care for most lesions amenable to either approach.
Dr Emily C Bartlett
Consultant Radiologist, Royal Brompton Hospital, London.
Guy’s and St Thomas’ NHS Foundation Trust
Honorary Senior Clinical Lecturer, NHLI, Imperial College London.
- Balasubramanian P, Abia-Trujillo D, Barrios-Ruiz A, Garza-Salas A, Koratala A, Chandra NC, Yu Lee-Mateus A, Labarca G, Fernandez-Bussy S. Diagnostic yield and safety of diagnostic techniques for pulmonary lesions: systematic review, meta-analysis and network meta-analysis. Eur Respir Rev. 2024 Sep 18;33(173):240046.
- Heerink WJ, de Bock GH, de Jonge GJ, Groen HJ, Vliegenthart R, Oudkerk M. Complication rates of CT-guided transthoracic lung biopsy: meta-analysis. Eur Radiol. 2017 Jan;27(1):138-148. doi: 10.1007/s00330-016-4357-8. Epub 2016 Apr 23.
With the expansion of lung cancer screening and a surge in CT imaging, the demand for accurate, timely assessment of peripheral lung nodules has grown substantially. While guideline-driven nodule management algorithms help direct investigation, a tissue diagnosis is often needed for suspicious lesions.
Historically, CT-guided transthoracic needle biopsy (TTNB) has been the gold standard for sampling peripheral nodules. Performed by radiologists, TTNB is fast, cost-effective, and widely quoted to have diagnostic yields exceeding 90%. However, this headline figure often reflects inconsistent definitions of “diagnostic yield” — a point we’ll return to.
In contrast, traditional bronchoscopy has been limited by its inability to access peripheral lesions. But with evolving technologies — including radial probe ultrasound (EBUS-TBLB), electromagnetic navigation bronchoscopy (ENB), and robotic-assisted bronchoscopy (RAB) — we are seeing steadily improving performance, with ENB literature now reporting diagnostic rates around 70%.
A key issue lies in how diagnostic yield and accuracy are defined across studies. In TTNB literature, non-diagnostic samples (e.g. inflammatory changes) are frequently counted as true negatives after a period of follow-up, inflating yield. Bronchoscopy studies tend to apply more stringent definitions, often excluding such results. This inconsistency has made meaningful comparisons difficult and introduced potential bias. A recent Delphi consensus (1) has sought to standardise definitions across modalities, allowing for more valid comparisons — a crucial step exemplified in the recent VERITAS study.
VERITAS is a landmark publication, representing the first prospective RCT to directly compare TTNB with a bronchoscopic technique — in this case, ENB — using an identical definition of diagnostic yield. The results are striking: ENB was shown to be non-inferior to TTNB. The reported diagnostic accuracy of TTNB (73.6%) was notably lower than historical data, likely reflecting the stricter definitions now applied. Importantly, bronchoscopy was associated with significantly fewer complications.
This is a major step forward for interventional bronchoscopy. However, we should be cautious in interpreting the authors’ suggestion that ENB should be the default for all suitable cases. Several limitations must be acknowledged. Firstly, a cost-effectiveness analysis was not included. Peripheral bronchoscopy platforms — particularly ENB and RAB — can be expensive, and resource implications must be considered. Secondly, access to these technologies remains limited in the UK, and currently only a small number of trained clinicians perform them in regional centres. Widespread adoption will require investment in training and infrastructure, though trainee enthusiasm is encouraging, as shown in recent BTS surveys. Finally, VERITAS examined only ENB; many other bronchoscopic platforms exist and are in development. Comparative data across technologies will be vital to inform best practice.
In summary, VERITAS is a pivotal study that challenges the long-held dominance of TTNB, providing the first RCT evidence that bronchoscopy — when standardised and appropriately applied — can achieve comparable diagnostic outcomes with fewer complications. As we look ahead, further prospective studies and real-world evaluations will be key to shaping the future of peripheral lung nodule diagnosis in the UK and beyond.
Dr Haval Balata MBChB MRCP(UK) PhD
Consultant Respiratory Physician & Honorary Senior Lecturer
Manchester Thoracic Oncology Centre. Wythenshawe Hospital, Manchester.
Division of Infection, Immunity & Respiratory Medicine. School of Biological Sciences. The University of Manchester.
- Gonzalez, A. v., Silvestri, G. A., Yarmus, L. B., Almeida, N. D., Chen, A., Gesthalter, Y. B., Gilbert, C. R., Illei, P. B., Korevaar, D. A., Maldonado, F., Navani, N., Pasquinelli, M. M., Pastis, N. J., Rivera, M. P., Sears, C. R., Shojaee, S., Solomon, S. B., & Steinfort, D. P. (2024). Assessment of Advanced Diagnostic Bronchoscopy Outcomes for Peripheral Lung Lesions: A Delphi Consensus Definition of Diagnostic Yield and Recommendations for Patient-centered Study Designs. An Official American Thoracic Society/American College of Chest Physicians Research Statement. American Journal of Respiratory and Critical Care Medicine, 209(6), 634. https://doi.org/10.1164/RCCM.202401-0192ST
Reflection from Outgoing BTOG Trainee Representatives
Anand Sundaralingam & Gerard Walls
As we hand over the BTOG Trainee Representative role, we look back on many positive experiences and significant professional growth. What began as an opportunity to contribute on behalf of our peers has become one of the most rewarding aspects of our training, shaping both our careers and our outlook as new Consultants.
Medical training often limits opportunities to take on committee or leadership positions, despite these being central to life as a Consultant. Within thoracic oncology, diagnostic pathways and treatment options in lung cancer have become increasingly complex, and strong national connections have never been more important. As senior trainees, we also felt a responsibility to share knowledge and resources with more junior colleagues, helping to make their journey a little smoother and ensuring they could benefit from lessons we ourselves had learned along the way.
Serving as BTOG Trainee Representatives gave us the chance to do just that. As full members of the steering committee, we contributed to quarterly meetings — reporting on trainee issues, participating in wider discussions, and learning much about governance and collaboration with industry. These meetings offered invaluable insight into how decisions are made and how policy, education, and research are shaped at a national level. A particular highlight was the opportunity to build relationships with key opinion leaders across the lung cancer disciplines, which has already proved invaluable as we step into Consultant roles.
A driving mission of BTOG is to educate and drive-up standards for thoracic oncology nationally. Nowhere is this better reflected than in the online resource hub on the BTOG website, which has developed into a comprehensive and invaluable educational archive. Past conference sessions and resources are searchable, categorised, and accessible — a huge advantage for trainees trying to consolidate knowledge in specific areas or revisit important updates.
We were also fortunate to contribute to the BTOG Trainee Journal Club, which provides an innovative forum for peer education. Each session combines a trainee-led summary with commentary from an established field leader on recent landmark studies. This format has allowed us not only to sharpen our own critical appraisal skills but also to feel part of a broader conversation about how evidence translates into practice.
Beyond education, BTOG has actively supported the development of multicentre trainee-led collaborative projects, some of which have resulted in publications. These projects showcase the ability of trainees to generate meaningful, practice-informing research when supported by a national structure. Equally important has been our role in strengthening communication between trainees across the country, ensuring their views are represented and shaping what BTOG can offer them going forward.
The highlight of the BTOG calendar is, of course, the Annual Conference (Edinburgh, 4–6 March 2026). As trainee reps, we were closely involved in planning and delivery: shaping the trainee session, supporting the hospitality team with medical student helpers, scoring abstracts and posters, and gaining first-hand insight into how a large meeting is organised. Across the four conferences we supported, we saw how these events serve as focal points for knowledge, collaboration, and optimism — places where people at every stage of training and practice can feel connected to the wider thoracic oncology community.
Our involvement has been hugely rewarding, both in terms of professional development and in expanding our networks — advantages that continue to support us as we begin our Consultant careers in thoracic oncology. We feel fortunate to have had such a strong start through this role and are hopeful for the future of lung cancer research, education, and care under BTOG’s leadership. And we know that your new Trainee Representatives will continue to advocate for your evolving professional needs within the BTOG community as they embark on this exciting adventure – we wish them all the best.
BTOG Events
Noticeboard
Project RESCAN
Project RESCAN (Risk assEssment for Screening after lung CANcer) is a multi-centre Respiratory trainee-led project aiming to determine the proportion of radically-treated lung cancer patients who are eligible for lung cancer screening at 6 years post-treatment completion. If you’re interested in contributing, please fill the following online form:
Other event dates for your diary
Thoracic Oncology Conferences, Study Days and Other Events - please note that this list includes events from other organisations not related to BTOG - inclusion on this list does not suggest endorsement by BTOG.
Cancer Research UK Lung Cancer Centre of Excellence Conference
4th-6th November 2026
Manchester, UK
BIR Annual Congress 2026
12th-13th November 2026
Birmingham, UK
BTS Winter Meeting 2026
25th-27th November 2026
London, UK
ETOP Annual Meeting 2026
27th-28th November 2026
Zurich, Switzerland
ETOP Residential Workshop 2026
27th-28th November 2026
Zurich, Switzerland
2027
ASCO Annual Meeting 2027
4th- 8th June 2027
Chicago, IL
Also included are Useful Core Resources: educational resources, guidelines, and other materials relevant to UK thoracic oncology professionals from organisations worldwide.
You can choose a speciality and then filter by tumour type, theme, and sub-category if you wish.
You can also search text in titles and descriptions of all our resources. You can search by keyword(s) e.g. ‘lung cancer screening’, or presenter surname, e.g. Popat.