Using PD-L1 expression to determine non-small cell lung cancer (NSCLC) treatment is becoming standard of care, according to a presentation given at the 11th Annual New York Lung Cancer Symposium (November 12, 2016).
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The success of PD-1 and PD-L1 inhibitors for lung cancer has prompted the FDA to approve three of these immunotherapy drugs: pembrolizumab, ipilimumab, and nivolumab. Next, researchers must identify predictors and determinants of response to these drugs in order to personalize treatment plans that lead to better outcomes.
Matthew D Hellman, MD, Memorial Sloan Kettering Cancer Center, presented his research on using PD-L1 expression to determine appropriate treatment plans for patients with NSCLC at the New York Lung Cancer Symposium. Dr Hellman insists standard of care for NSCLC is shifting towards analysis of PD-L1 expression. In his own practice, testing for PD-L1 is routine in patients newly diagnosed with NSCLC, and patients who have >50% expression are given pembrolizumab as first-line therapy.
Whether or not patients need to be retested for PD-L1 if they relapse to help determine their second-line treatment is a topic of debate. Dr Hellman has found retesting for PD-L1 to be unnecessary because PD-L1 expression tends not to change over time. In one study of 57 patients with NSCLC who were tested for PD-L1 expression before and after TKI treatment, 72% of the patients saw no change in their levels of PD-L1 expression. Dr Hellman also asserted that PD-L1 testing is unnecessary for determining second-line immunotherapy sequences and combinations. Increased PD-L1 is linked to increased benefit, he said, but does not give any indication as to which second-line therapy to administer to patients.
Dr Hellman noted the PD-L1 expression biomarker is not necessarily predictive of treatment response in patients with small cell lung cancer (SCLC). Though PD-L1 is an important predictor of response to pemtrolizumab treatent in NSCLC, its role in SCLC, as well as the roles of biomarkers estimated glomerular filtration rate (EGFR) and anaplastic lymphoma kinase (ALK), are yet to be determined.
“Part of the job moving forward is to see how do these markers play together? The progress we’ve made so far is profound, especially for our patients,” concluded Dr Hellman.
