Executive Summary
Best of Lung Cancer Science at 2025 ELCC Conference
The STS 2025 Best of Lung Cancer Science special edition podcast series offers members direct access to the most relevant and practice-changing science in lung cancer, curated and interpreted by thoracic surgeons for thoracic surgeons.
This executive summary breaks down the key takeaways on pivotal research and emerging themes from top studies presented at the 2025 European Lung Cancer Congress (ELCC).
Discover new perspectives on the science that is redefining the surgical management and multidisciplinary care of lung cancer, as shared by Erin Gillaspie, MD, Chief of Thoracic Surgery, CHI Health, and podcast host, and Paula Ugalde, MD, Associate Surgeon in the Division of Thoracic Surgery at Brigham and Women’s Hospital and Associate Professor of Surgery at Harvard Medical School.
1. Rethinking Restaging in the Neoadjuvant Era
• Dr. Gillaspie and Dr. Ugalde highlighted one of the most debated issues in thoracic oncology currently: how to accurately restage and interpret response after neoadjuvant chemo-immunotherapy.
• Traditional imaging, particularly PET scans, can be misleading after immunotherapy due to treatment-related inflammation and pseudo progression. Many institutions, including their own, are shifting toward CT-based assessment to reduce unnecessary invasive restaging.
• Dr. Ugalde noted that “progression” is no longer a binary concept—small changes in lymph node size or persistent uptake may not represent viable disease. For borderline cases, however, she continues to perform mediastinal restaging (via mediastinoscopy or EBUS) to refine prognosis and guide operative planning.
• Both surgeons emphasized the need for better biologic markers, such as ctDNA or other molecular surrogates, to identify true responders and avoid surgery in patients unlikely to benefit.
2. Redefining Resectability: Beyond Rigid Boundaries
• With the launch of the 9th edition Tumor-Node-Metastasis (TNM) staging system and the subdivision of N2 disease (single-station N2A vs. multi-station N2B), thoracic surgeons are re-examining what “resectable” really means in the immunotherapy era.
• Dr. Ugalde, who serves on the IASLC Staging and Prognostic Factors Committee, clarified that TNM’s role is prognostic, not prescriptive. Despite the prognostic differences between N2A and N2B, she emphasized that resectability must be a dynamic, multidisciplinary decision, often reassessed after neoadjuvant therapy.
• “Is resectability the question?” Dr. Ugalde asked. “Maybe it’s resectability after induction that matters.” Both surgeons agreed that the definition of resectability varies by surgeon expertise and institutional experience. The upcoming MDT Bridge trial, which evaluates borderline stage III patients after neoadjuvant chemo-IO before deciding on surgery versus chemoradiation, represents a new paradigm of adaptive treatment planning.
• Rather than seeing radiation and surgery as competing modalities, Dr. Ugalde urged closer collaboration with radiation oncologists to achieve optimal local control, particularly for complex stage III disease.
3. Artificial Intelligence (AI): Enhancing Precision Across Disciplines
• AI emerged as a major theme at ELCC 2025, spanning radiology, pathology, and surgical planning. Dr. Ugalde described her enthusiasm for AI-assisted pathology, which markedly reduces interobserver variability and enhances diagnostic consistency. At Brigham and Women’s, her team is exploring participation in trials applying AI to automate pathologic response assessments.
• She also highlighted the use of AI-based 3D reconstructions for surgical quality assurance. In one collaboration with a Dutch research group, postoperative imaging was analyzed with AI to confirm correct identification and resection of arteries, veins, and bronchi during segmentectomy—a potential leap forward in surgical self-assessment and training.
• “AI isn’t replacing us—it’s standardizing and elevating our precision,” Dr. Ugalde said. Dr. Gillaspie added that similar applications in radiology and cytology are helping expand access in resource-limited settings by enabling rapid, AI-assisted adequacy checks for biopsy samples.
• Dr. Ugalde and Dr. Gillaspie agreed that AI will soon become integral to screening programs, response evaluation, and multimodal decision-making, serving as a powerful equalizer across institutions.
4. Balancing Duration and Quality: The De-escalation Debate
• De-escalation emerged as both a clinical and philosophical theme at ELCC. With trials now showing excellent outcomes in patients achieving complete pathologic response (pCR) after neoadjuvant chemo-immunotherapy, many centers are withholding adjuvant therapy in these patients.
• Dr. Ugalde questioned the rationale for prolonged systemic treatment when “the tumor is dead,” calling for pragmatic strategies that balance efficacy, toxicity, and patient quality of life. She noted that while targeted therapy (e.g., osimertinib, ALK inhibitors) may require longer duration in advanced or high-risk patients, the principle of “more isn’t always better” should guide therapy in resected, pCR-positive patients.
• “We must listen to what the patients want—survival, cure, or quality of life—and build treatment around that,” Dr. Ugalde emphasized. Dr. Gillaspie echoed the importance of continued dialogue between patients and care teams, underscoring that treatment decisions must remain aligned with patients’ goals and individualized.
Main Points:
• Restaging after neoadjuvant therapy remains complex; CT is favored over PET to avoid misinterpreting immune-related inflammation.
• Resectability is becoming a fluid, multidisciplinary decision, reassessed after induction therapy and guided by team expertise.
• AI technologies are improving standardization in pathology, radiology, and surgery, offering new quality metrics and global access.
• De-escalation of adjuvant therapy—especially in patients with pCR—reflects a growing shift toward precision care and patient-centered outcomes.
Bottom Line:
The 2025 ELCC discussions, as captured by Drs. Gillaspie and Ugalde, reflect a lung cancer field entering a new phase of collaboration, adaptivity, and precision. Multidisciplinary teamwork now drives every major decision—from staging to surgery to systemic therapy.
As Dr. Ugalde concluded, “Our mission is not just to operate—it’s to align science, teamwork, and patient goals to truly change lives.”