Top 5 questions from BTG Lung 2026

One thing I noticed at BTG Lung 2026 was how many of the most important questions in early-stage EGFR-mutated NSCLC still don't have clear answers.

We know osimertinib works. That isn't really the debate anymore. The debate is everything that comes after.

Can some patients safely skip adjuvant chemo? Is 3 years of osi the right duration, or should some patients receive longer treatment while others stop sooner? Should ctDNA eventually guide when we start, stop or escalate therapy?

Then there are the perioperative questions. Should osi be given before surgery, after surgery or both? And when a patient relapses after adjuvant osi, what's the next step?

These aren't edge cases. These are the conversations happening in clinic and tumor boards every week.

When you're in a data-free zone, oncologists can't stop making decisions. We weigh competing risks, think about tumor biology, consider the patient's goals and decide what gives that patient the best chance.

That's one of the most fascinating parts of oncology. The hardest decisions usually aren't choosing between a treatment that works and one that doesn't. They're choosing between 2-3 reasonable approaches when no one knows which one is best.

That's where experience matters. Two physicians can look at exactly the same data and arrive at different but equally defensible recommendations.

Curious how others are approaching these cases. For anyone treating early-stage EGFR-mutated NSCLC, where do you think is the biggest area of uncertainty?

Chemo selection? Treatment duration? ctDNA-guided management? Perioperative sequencing?

Or is there another question that's top of mind for you?