Dr. Desai on Immunotherapy in Patients With NSCLC and Low PD-L1 Expression

Amishi Desai, MD, assistant professor of medicine at Upstate University Hospital, discusses the use of immunotherapy in patients with non—small cell lung cancer (NSCLC) with PD-L1 expression less than 1%.

Results from the CheckMate-227 trial can help inform physicians on whether to use immunotherapy with PD-L1 expression less than 1%, says Desai. It is known that these patients benefit from combination chemotherapy plus immunotherapy based on results of the KEYNOTE-189 and KEYNOTE-407 trials.

Further down the line, physicians may be able to use tumor mutational burden (TMB) to direct treatment. This is a specialized test that has to be done with certain assays, such as FoundationOne. High TMB is defined as anything more than 10 mut/mB, and low is anything below than that. According to the CheckMate-227 trial, a patient who has a high TMB—regardless of their PD-L1 status—can experience an improved progression-free survival and overall survival with a combination of standard chemotherapy plus nivolumab (Opdivo). These patients were also exposed to nivolumab and ipilimumab (Yervoy). Those with high TMB showed a robust response, and an even better response than with chemotherapy plus ipilimumab.