Science, Survival, and What Comes Next: Key Takeaways from the 2026 IASLC TTLC Meeting

The 2026 IASLC Targeted Therapies in Lung Cancer (TTLC) meeting proved to be one of the most energizing gatherings in recent memory for the lung cancer community. From deeply personal patient stories to cutting-edge science on targeted therapies, antibody-drug conjugates (ADCs), and circulating tumor DNA (ctDNA), the meeting offered both inspiration and a clear-eyed look at the work still ahead. Estelamari Rodriguez, MD, MPH, thoracic oncologist at the University of Miami Sylvester Comprehensive Cancer Center, shared her reflections on the highlights and hard questions that defined this year’s program.

The Power of the Patient Voice

The patient perspective was woven prominently into the meeting’s fabric. Another session featured Jane Perlmutter, a patient advocate with a remarkable personal story of facing multiple cancers across her lifetime. She was introduced by her own oncologist, Shirish Gadgeel, MD, one of the meeting’s chairs.

“She was a really powerful voice for what patient advocates can bring to the table,” Rodriguez said. “I also found her presentation and the fact that she was introduced by her own doctor really touching—that this meeting not only was talking about science but also talking about patients being partners in the whole enterprise of developing the best therapies.”

Co-Mutations and the Evolving Complexity of EGFR Lung Cancer

Among the scientific sessions, Rodriguez highlighted a talk on co-occurring mutations in EGFR-driven lung cancer—a topic with growing clinical relevance as next-generation sequencing (NGS) becomes more widely used.

“We thought of personalized medicine as specific oncogenic driver tumors. But as we’re doing more in-depth NGS analysis, we’re finding that patients can have multiple mutations, and there’s very little research to understand the significance of co-mutations,” she explained. “We know that in EGFR-mutant lung cancer, it can mean that you have more aggressive disease, and some of the new options to escalate are all about covering these other co-mutations.”

Rodriguez also pointed to the transformative potential of ctDNA monitoring in this context.

“We are able to monitor patients with ctDNA in a way that we couldn’t before, where we have patients on one treatment and we can follow the ctDNA—that mutation would go down and another one emerge. That information requires research and guidance on what to do next,” she said.

Early Stage Lung Cancer: A Multidisciplinary Conversation

Rodriguez led and participated in a session dedicated to early-stage lung cancer, a fitting arena for the meeting’s emphasis on bringing specialties together. The panel included a radiation oncologist, thoracic surgeon Jessica Donington, MD, from the University of Chicago, and medical oncologists.

“You can’t talk about early stage lung cancer without having everyone in the room,” Rodriguez noted.

A significant focus was the real-world impact of neoadjuvant chemoimmunotherapy on surgical pathways. Although 3 major trials have demonstrated improvements in pathological complete response, Donington raised important concerns about treatment attrition.

“There’s a real delay and potential attrition to these neoadjuvant approaches for patients. They get chemoimmunotherapy, which may delay their treatment at least 12 weeks—and then some patients do have attrition, like they have toxicity from that initial induction that doesn’t allow them to get the surgery that they would have had,” Rodriguez explained. “If we lost patients [who] could have had a curative surgery in that process of the attrition of the peri-adjuvant therapy, that’s something we need to take seriously.”

A practical gap also emerged around reflex molecular testing. Survey data presented during the session revealed that only about 60% of institutions had reflex testing protocols and that barely 46% of patients had actionable mutation results in hand before their initial surgical consultation.

“We have all this science about how we can optimize care for patients, but we may not have all that information up front. Getting that information means delays in care, and we have to get better at doing that,” Rodriguez said.

ctDNA, MRD, and the Promise of Real-Time Surveillance

Ash A. Alizadeh, MD, PhD from Stanford presented on the use of ctDNA for minimal residual disease (MRD) testing—a topic Rodriguez described as one of the session’s standout discussions.

“The technology is there. If we don’t have the data prospectively to make decisions, we are definitely seeing trial after trial showing that ctDNA can be prognostic—so that patients who clear the ctDNA do better, and that it can guide your surveillance. If a patient is not clearing ctDNA or has MRD, there’s a very high likelihood of recurrence,” she summarized. “The next step is going to be how to pair that information with the next treatment option for patients, and when you can act on it.”

Immunotherapy Updates and Open Questions in the Perioperative Setting

Updated survival data from KEYNOTE-671 (NCT03425643) reinforced the perioperative immunotherapy paradigm for locally advanced, resectable disease. But Rodriguez flagged important unanswered questions that future trials will need to address.

“If patients have a complete pathologic response, do they require more adjuvant immunotherapy? There are national trials that are trying to answer those questions,” she said. Among them, the SWOG 2414 trial [NCT06498635] will randomize patients with pathologic complete response to durvalumab versus surveillance—a design Rodriguez called critical, noting that “we could be overtreating patients and exposing them to toxicity that we will learn was not required.”

For patients who do not achieve a pathologic complete response, the landscape remains more challenging. Rodriguez noted that some of these patients may harbor actionable mutations requiring targeted therapy, whereas others may have primary resistance to chemoimmunotherapy—a group with significant unmet need.

Antibody-Drug Conjugates and What’s Next

One of the more forward-looking themes of the meeting was the potential role of ADCs, particularly TROP2 inhibitors and others, in the perioperative setting.

“Those are drugs that deliver chemotherapy in a more precise way. There are some international trials that will take some time to read out but are really important, because we could definitely bring some of the newer treatments from the metastatic setting into the perioperative setting,” Rodriguez said.

She also voiced optimism about reducing reliance on highly toxic chemotherapy backbones.

“We are going to learn that perhaps some patients will not need as much chemotherapy as we had done in the past, and we may move away from cisplatin, which is such a toxic drug to use in the adjuvant setting,” she said.

A Call to the Community

Rodriguez closed her reflections with a note that extended beyond the conference walls—toward the community oncologists who treat the majority of patients with lung cancer in the United States.

“In the community, these multidisciplinary discussions are very difficult to have because you have providers [who] are not meeting at the same time; they don’t have a tumor board at the same time. So really, how can providers in the community have these discussions? And how important it is to involve all the members of the team, as difficult as it is, because it will really give patients better options and better outcomes,” she said.

It was a fitting final thought from a meeting that balanced scientific ambition with everyday patient care and a reminder that the distance between discovery and delivery still requires communication and collaboration from everyone in the field.