We were excited to be invited to attend the first in-person BTOG Summer Meeting 2022, since 2020. A day of education, discussion, and networking and a perfect opportunity to share the work of the Charity with others. Take away messages:-

Lung Cancer screening:

Targeted Lung Cancer (LC) screening shows favourable clinical outcomes and is cost-effective. More needs to be done to enable those who do not ‘trip the risk threshold’ to access CT scans earlier.

The Dutch Belgian LC screening programme (NELSON) showed a 26% reduction in LC mortality in at-risk males 50 years +.

Screening will pick up a mix of LCs, both aggressive and less so. Curability depends on the biological nature of the disease. Not all Lung Cancers are the same and not all LCs are smoking-related. The stigma of the perception of LC as a lifestyle-driven disease continues and must be addressed.

There is a capacity crisis in the NHS. There are not enough CT scanners or trained radiologists and the downstream availability and cost of treatment are concerning.

However ‘You’d be a fool not to do it i.e. screen for LC.

The Future

Pan- screening: screening for different cancers completed in 1 appointment e.g. breast/prostate, lung cancer, bowel.
Use Artificial Intelligence to triage CT scans.
Cancer Concern Hotlines are to be piloted in the UK. Concerned adults can make a direct referral for a CT scan. This would give an alternative route that goes around primary care (GP) and allows younger, lower-risk adults direct access to the lung cancer diagnostic pathway.
Novel screening methods are being investigated e.g. a biomarker test for lung cancer that can be done at home via a breath exhalation PCR test.

Challenges in the Lung Cancer Clinic

Brain metastases

The Brain is a different organ and needs to be treated differently.

There has been an 82% decrease in the development of brain metastases in patients taking Osimertinib compared with those on other treatments.

Guidelines are needed for the equitable treatment of brain metastases across the UK, especially in relation to the sequencing of treatment.

Whole brain radiation therapy is being questioned in relation to its toxicity, impact on the patient’s quality of life, and long terms effects. Saving as many healthy brain cells as possible through careful and precise preparation & planning is crucial.

Neuro-oncology is a rapidly evolving area and needs to be part of the decision-making around treatment.

EGFR Exon 20 insertion Positive NSCLC

Exon 20 insertion is a distinct variant and approximately 20% of patients are missed at diagnosis. Improvements in genetic testing will begin to address this.

Two new drugs are entering the treatment arena for Exon 20 insertion patients – Amivantamab and Mobocertinib. Amivantamab has MHRA approval and both are currently under review for potential approval and NHS funding in the UK.

Disease complexity is increasing

Stage IV lung cancer is becoming more complex.

In the rapidly evolving area of treatment, there is a need to build better structures between the existing MDT members and neuro-oncology, surgery etc.

Patients with acquired resistance prefer to stay on a TKI and there are 4th generation TKI’s coming.

When presented with treatment options the patient must be supported in deciding on the best treatment option for them. Whatever the process the patient should feel able to make a decision that they are comfortable with and understand.