In this edition of Thorax Spiro and colleagues¹ report their perceived failure to recruit patients to the Big Lung trial (BLT). It is appropriate to consider why only 9% of eligible patients entered the trial and what impact this has on this important study.

BLT addresses the role of cisplatin-based combination chemotherapy in non-small cell lung cancer (NSCLC). This is not a trivial regime in a patient group with a median age of 67 years, many of whom will have major vascular co-morbidities. That fewer than one sixth of patients were deemed ineligible for these reasons is surprising. It is also noteworthy that 12% of patients had elective chemotherapypresumably all with inoperable disease since there is no current evidence to justify routine postoperative adjuvant therapy. It is disappointing, but hardly surprising in the current UK research environment with its dependence on the pharmaceutical industry, that 13% of patients were treated . . . [Full text of this article]