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PD-L1 Status in Second-Line Lung Adenocarcinoma

Insights From:Anders Mellemgaard, MD, Herlev University Hospital; Sanjay Popat, PhD, FRCP, The Royal Marsden Hospital;Martin Reck, MD, PhD, Hospital Grosshansdorf
Published: Wednesday, Nov 16, 2016


Transcript:

Anders Mellemgaard, MD:
I think it’s important to test for PD-L1 status. PD-L1 is a fairly good predictor of outcome of immune checkpoint inhibitors. So, in order to select the right treatment for a particular patient, PD-L1 testing is really important. But, other things also go into the evaluation as we try to determine a proper treatment for a particular patient.

An issue that we really have not resolved is, what is the cutoff? When is a patient a good candidate for checkpoint inhibitor treatment, and when is the PD-L1 expression too low? I think we have seen many different cutoffs in clinical trials. It appears that a minimum cutoff of 1% is certainly something that we can use. It’s also quite clear that if we raise the bar, we will be even better at selecting checkpoint inhibitor treatment for patients.

I think it’s quite clear that PD-L1 status predicts the outcome of checkpoint inhibitors. So, the higher the score, the better the outcome can be expected. And that’s not related to toxicity. A patient who has a high PD-L1 expression has a better chance of a good outcome, but does not have an increased risk of toxicity. So, the benefit for the patient really has a lot to do with the particular expression within the tumor of this particular patient.

Martin Reck, MD, PhD: Immunotherapy has become an additional treatment option for our patients with pretreated advanced non–small cell lung cancer. We have seen in two really large trials that there is a relation between the PD-L1 expression and the efficacy of anti–PD-1 antibodies, and this we have seen predominantly in patients with advanced non-squamous non–small cell lung cancer, in patients with pretreated adenocarcinoma. In my practice, when I do have a pretreated patient with adenocarcinoma, I would like to see the PD-L1 expression status. I would like to test my patient for the PD-L1 expression status, because this is one additional instrument for my selection of treatment. So, if I would have a patient in a good shape with a clear PD-L1 negative tumor, I also would think about first giving this patient a chemotherapy as a second-line treatment option.

Transcript Edited for Clarity
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Transcript:

Anders Mellemgaard, MD:
I think it’s important to test for PD-L1 status. PD-L1 is a fairly good predictor of outcome of immune checkpoint inhibitors. So, in order to select the right treatment for a particular patient, PD-L1 testing is really important. But, other things also go into the evaluation as we try to determine a proper treatment for a particular patient.

An issue that we really have not resolved is, what is the cutoff? When is a patient a good candidate for checkpoint inhibitor treatment, and when is the PD-L1 expression too low? I think we have seen many different cutoffs in clinical trials. It appears that a minimum cutoff of 1% is certainly something that we can use. It’s also quite clear that if we raise the bar, we will be even better at selecting checkpoint inhibitor treatment for patients.

I think it’s quite clear that PD-L1 status predicts the outcome of checkpoint inhibitors. So, the higher the score, the better the outcome can be expected. And that’s not related to toxicity. A patient who has a high PD-L1 expression has a better chance of a good outcome, but does not have an increased risk of toxicity. So, the benefit for the patient really has a lot to do with the particular expression within the tumor of this particular patient.

Martin Reck, MD, PhD: Immunotherapy has become an additional treatment option for our patients with pretreated advanced non–small cell lung cancer. We have seen in two really large trials that there is a relation between the PD-L1 expression and the efficacy of anti–PD-1 antibodies, and this we have seen predominantly in patients with advanced non-squamous non–small cell lung cancer, in patients with pretreated adenocarcinoma. In my practice, when I do have a pretreated patient with adenocarcinoma, I would like to see the PD-L1 expression status. I would like to test my patient for the PD-L1 expression status, because this is one additional instrument for my selection of treatment. So, if I would have a patient in a good shape with a clear PD-L1 negative tumor, I also would think about first giving this patient a chemotherapy as a second-line treatment option.

Transcript Edited for Clarity
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