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- Title
PD-L1 testing for lung cancer in the UK: recognizing the challenges for implementation.
- Authors
Cree, Ian A; Booton, Richard; Cane, Paul; Gosney, John; Ibrahim, Merdol; Kerr, Keith; Lal, Rohit; Lewanski, Conrad; Navani, Neal; Nicholson, Andrew G; Nicolson, Marianne; Summers, Yvonne
- Abstract
A new approach to the management of non-small-cell lung cancer ( NSCLC) has recently emerged that works by manipulating the immune checkpoint controlled by programmed death receptor 1 ( PD-1) and its ligand programmed death ligand 1 ( PD-L1). Several drugs targeting PD-1 (pembrolizumab and nivolumab) or PD-L1 (atezolizumab, durvalumab, and avelumab) have been approved or are in the late stages of development. Inevitably, the introduction of these drugs will put pressure on healthcare systems, and there is a need to stratify patients to identify those who are most likely to benefit from such treatment. There is evidence that responsiveness to PD-1 inhibitors may be predicted by expression of PD-L1 on neoplastic cells. Hence, there is considerable interest in using PD-L1 immunohistochemical staining to guide the use of PD-1-targeted treatments in patients with NSCLC. This article reviews the current knowledge about PD-L1 testing, and identifies current research requirements. Key factors to consider include the source and timing of sample collection, pre-analytical steps (sample tracking, fixation, tissue processing, sectioning, and tissue prioritization), analytical decisions (choice of biomarker assay/kit and automated staining platform, with verification of standardized assays or validation of laboratory-devised techniques, internal and external quality assurance, and audit), and reporting and interpretation of the results. This review addresses the need for integration of PD-L1 immunohistochemistry with other tests as part of locally agreed pathways and protocols. There remain areas of uncertainty, and guidance should be updated regularly as new information becomes available.
- Subjects
LUNG cancer; IMMUNITY; LIGANDS (Biochemistry); CANCER cells; IMMUNOHISTOCHEMISTRY
- Publication
Histopathology, 2016, Vol 69, Issue 2, p177
- ISSN
0309-0167
- Publication type
Article
- DOI
10.1111/his.12996