Dr. Gandara on the Utility of TMB in NSCLC

David R. Gandara, MD, discusses the utility of tumor mutational burden in non–small cell lung cancer.

David R. Gandara, MD, director, Thoracic Oncology Program, professor, senior advisor to director, UC Davis Comprehensive Cancer Center, and a 2017 Giant of Cancer Care® in Lung Cancer, discusses the utility of tumor mutational burden (TMB) in non–small cell lung cancer (NSCLC).

​Along with PD-L1​, recent data suggest that TMB is another predictive biomarker for checkpoint inhibitors, says Gandara. However, TMB varies significantly between different cancer types and within individual patients, making TMB a complex biomarker.

​Recently, pembrolizumab (Keytruda) received its second biomarker-based indication from the FDA for adult and pediatric patients with unresectable or metastatic TMB-high solid tumors. According to Gandara, while this approval is a step forward in this space, it raises questions that need to be answered.

Notably, NSCLC is associated with a high mutational burden compared with other cancers as many patients were former smokers. As such, TMB may have many implications regarding the use of immunotherapy in NSCLC, Gandara concludes.