Journal
JOURNAL OF THORACIC ONCOLOGY
Volume 15, Issue 9, Pages 1449-1459Publisher
ELSEVIER SCIENCE INC
DOI: 10.1016/j.jtho.2020.04.026
Keywords
PD-L1; Immune checkpoint inhibitor therapy; Metastatic non -small cell lung cancer; Heterogeneity
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Funding
- University of Texas MD Anderson's Lung Cancer Moon Shot Program
- MD Anderson Physician Scientist Program
- MD Anderson Visiting Scholar Program
- Cancer Prevention and Research Institute of Texas Multi-Investigator Research Award grant [RP160668]
- T.J. Martell Foundation
- Advanced Non-Small-Cell Lung Holistic Registry
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Introduction: Programmed death-ligand 1 (PD-L1) expression may vary in different disease sites and at different time points of the disease course. We aimed to investigate PD-L1 heterogeneity and its usefulness as a predictive value for immune checkpoint inhibitor (ICI) therapy in patients with NSCLC. Methods: PD-L1 expression was analyzed in 1398 patients with NSCLC. The predictive value of PD-L1 for ICIs in 398 patients with metastatic NSCLC was assessed. Results: PD-L1 was significantly associated with biopsy sites (p = 0.004). Adrenal, liver, and lymph node (LN) metastases had the highest PD-L1 expression as a continuous variable and at 1% or 50% cutoff. PD-L1 expression was lower in bone and brain metastases. Among 112 patients with two specimens tested, 55 (49%) had major changes in PD-L1 falling into different clinically relevant categories ( 1%, 1%-49%, 50%) at different time points. Previous ICI therapy was associated with significant decrease in PD-L1 compared with treatment-naive counterparts (p = 0.015). Patients with metastatic NSCLC treated with ICI (n = 398) were divided into three cohorts on the basis of biopsy sites: lung (n = 252), LN (n = 85), and distant metastasis (n = 61). Higher PD-L1 in lung or distant metastasis specimens was associated with higher response rate, longer progression-free survival, and overall survival. However, PD-L1 in LN biopsies was not associated with either response or survival. Conclusions: PD-L1 varies substantially across different anatomical sites and changes during the clinical course. PD L1 from different biopsy sites may have different predictive values for benefit from ICIs in NSCLC.
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