{"entity":{"id":"big-lung-trial","kind":"trial","name":"Big Lung Trial","aka":["BLT"],"tldr":"The British trial that asked, without enthusiasm or spin, what chemotherapy is actually worth in lung cancer, and found it worth nine weeks in advanced disease and nothing at all after surgery or radiotherapy.","summary":"The Big Lung Trial was designed to be ordinary: a large pragmatic test, in four separate primary-treatment settings, of the conclusion of the 1995 non-small-cell lung cancer meta-analysis. In the supportive care setting it randomised 725 people and found that chemotherapy improved survival with a hazard ratio of 0.77 (95 percent confidence interval 0.66 to 0.89, p = 0.0006), a median gain from 5.7 to 8.0 months, or nine weeks. There were 19 treatment-related deaths (5 percent), no significant differences on the pre-defined quality-of-life endpoints, and the regimens were cost-effective because the extra cost was offset by longer survival.\n\nIn the surgical setting it randomised 381 people and found no overall survival benefit (hazard ratio 1.02, 0.77 to 1.35, p = 0.90). In the radical radiotherapy setting it randomised 288 and found none either (hazard ratio 1.07, 0.84 to 1.38), closing early for slow accrual. The trial also produced one of the most useful pieces of honesty in British trial history: of 688 newly diagnosed patients at two London centres, only 63 (9.2 percent) entered, and of the 253 who were potentially eligible, 186 (73.5 percent) refused.","status":"mixed","asOf":"2026-09-25","links":[{"label":"Thorax 2004 (supportive care setting)","url":"https://europepmc.org/article/MED/15454647"},{"label":"European Journal of Cardio-Thoracic Surgery 2004 (surgical setting)","url":"https://europepmc.org/article/MED/15200998"},{"label":"Thorax 2000 (recruitment)","url":"https://europepmc.org/article/MED/10817793"}],"tags":["uk","lung","pragmatic-trial"],"related":[],"cancers":["nsclc","lung-cancer"],"sections":["chemotherapy"],"technologies":["cytotoxic-chemotherapy"],"targets":[],"drugs":["cisplatin"],"companies":[],"institutions":[],"pathways":[],"terms":[],"trials":[],"people":[],"bottlenecks":[],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"phase":"3","setting":"Cisplatin-based chemotherapy added to supportive care, to surgery or to radical radiotherapy in non-small-cell lung cancer: a deliberately plain, large pragmatic trial testing whether the 1995 meta-analysis was right","sponsor":"Medical Research Council and the British Thoracic Oncology Group","result":"In advanced disease, chemotherapy gave a hazard ratio for death of 0.77 and a median gain of nine weeks; in the surgical and radical radiotherapy settings there was no survival benefit.","yearReported":2004,"enrolled":1394,"enrolledBasis":"randomised","enrolledNote":"The trial randomised in four settings and reported separately: 725 in the supportive care comparison, 381 in the surgical comparison and 288 in the radical radiotherapy comparison.","outcomes":[]},"route":"/trials/big-lung-trial/","neighbours":{"cancer":[{"id":"lung-cancer","kind":"cancer","name":"Lung cancer (all types)","route":"/cancers/lung-cancer/"},{"id":"nsclc","kind":"cancer","name":"Non-small-cell lung cancer","route":"/cancers/nsclc/"}],"section":[{"id":"chemotherapy","kind":"section","name":"Chemotherapy","route":"/fronts/chemotherapy/"}],"technology":[{"id":"cytotoxic-chemotherapy","kind":"technology","name":"Cytotoxic chemotherapy","route":"/technologies/cytotoxic-chemotherapy/"}],"drug":[{"id":"cisplatin","kind":"drug","name":"Cisplatin","route":"/drugs/cisplatin/"}],"trial":[{"id":"quartz","kind":"trial","name":"QUARTZ","route":"/trials/quartz/"}]}}