At the European Lung Cancer Congress (ELCC), the prestigious Heine H. Hansen Award was presented to Professor Keith Kerr, a pathologist from the Aberdeen Royal Infirmary, in recognition of his outstanding contributions to oncology research. The announcement was made by ELCC co-chairs Professor Enrico Ruffini, a thoracic surgeon from the Università di Torino, and Professor Myung-Ju Ahn, a medical oncologist from Samsung Medical Center - Sungkyunkwan University School of Medicine, Seoul/KR.
Professor Kerr is widely known for his role in developing numerous clinical guidelines and contributing to the World Health Organization (WHO) classification of lung cancers.
In his keynote lecture, Professor Kerr explored the ongoing evolution of lung cancer pathology, emphasizing the critical role pathologists play in translating scientific discoveries into clinical practice.
How has your work as a pathologist influenced lung cancer management?
Keith Kerr: Twenty-five years ago, I was involved in a study exploring the relationship between lung cancer and the immune system (Histopathology. 1998;33:55–63). We observed evidence of partial tumor regression induced by the immune system in some patients who had undergone tumor resection. Although rare—a phenomenon previously reported in melanoma and other tumor types—these immune responses were associated with unexpectedly favorable prognoses. Years later, we observed similar pathological changes in lung cancer specimens following neoadjuvant immunotherapy, supporting the notion that immune modulation can benefit a broader patient population.
In another study, I helped establish a link between atypical adenomatous hyperplasia and lung adenocarcinoma in Western Caucasian populations (Br J Cancer. 2000;83:632–636), a connection that had previously only been confirmed in Japanese cohorts.
In the diagnostic field, I contributed to the recommendation of using the classification “non-small cell lung cancer—not otherwise specified (NSCLC-NOS)” for indeterminate cases. This paved the way for the first publication supporting the use of immunohistochemistry (IHC) to predict the likely cell type in small biopsy samples from NSCLC-NOS patients (J Clin Pathol. 2000;53:537–540). Incorporating NSCLC-NOS into clinical guidelines alongside IHC testing has significantly improved diagnostic accuracy, thereby facilitating the development of more precise treatment strategies.
How has the role of pathology in lung cancer evolved over the years?
Keith Kerr: Forty years ago, medical oncology as a specialty was still in its infancy. Surgery was the mainstay of treatment, and there was minimal academic interaction between surgeons and pathologists. Today, that dynamic has changed dramatically. Driven by the needs of modern oncology, pathologists have become integral members of multidisciplinary teams.
One of the early turning points was the introduction of different chemotherapy regimens for patients with small cell lung cancer. Initially, treatment protocols were largely uniform, but with the advent of newer chemotherapy agents, clinicians needed pathologists to distinguish between squamous cell carcinoma and adenocarcinoma to guide therapy choices.
Later, the emergence of molecular targeted therapies brought greater awareness of oncogenic driver mutations and genetic alterations, with pathologists playing a pivotal role in biomarker identification. More recently, the rise of immunotherapy has highlighted the importance of pathologic features such as PD-L1 expression, which are now central to treatment decision-making in oncology.
Today, the use of pathological features as biomarkers to identify patients most likely to benefit from specific therapies is a well-established standard that continues to evolve. Key areas of ongoing focus include whole-genome DNA/RNA sequencing and the clinical integration of complex genomic data. New technologies such as artificial intelligence (AI) will undoubtedly drive further advances in pathology, though they also present unique challenges—pathologists must learn to use these tools effectively without being distracted by hype.
How can today’s lung cancer pathologists help advance the field?
Keith Kerr:There remains a disconnect between clinical lung cancer treatment and its scientific underpinnings. Pathologists are uniquely positioned to bridge this gap, enabling deeper understanding and integration across disciplines. Our field must move beyond a reactive stance and take a proactive approach to embracing change.
Most importantly, we must lead—not follow—in adapting to new developments. By bridging basic science and clinical application, we can help accelerate the evolution of precision medicine and continue driving progress in lung cancer care.
