Significance and implications of FDA approval of pembrolizumab for biomarker-defined disease

The U.S. Food and Drug Administration (FDA) recently approved pembrolizumab, an anti-programmed cell death protein 1 cancer immunotherapeutic, for use in advanced solid tumors in patients with the microsatellite-high/DNA mismatch repair-deficient biomarker. This is the first example of a tissue-agnostic FDA approval of a treatment based on a patient's tumor biomarker status, rather than on tumor histology. Here we discuss key issues and implications arising from the biomarker-based disease classification implied by this historic approval.