From the Guidelines
Measuring Programmed Death-Ligand 1 (PD-L1) expression has a significant impact on management with immunotherapy in non-small cell lung cancer (NSCLC), triple-negative breast cancer, urothelial carcinoma, head and neck squamous cell carcinoma, esophageal squamous cell carcinoma, and cervical cancer.
Cancer Types Influenced by PD-L1 Expression
- Non-small cell lung cancer (NSCLC): PD-L1 expression levels determine first-line pembrolizumab eligibility, with scores ≥50% qualifying for monotherapy and ≥1% for combination therapy with chemotherapy 1.
- Triple-negative breast cancer: atezolizumab plus nab-paclitaxel is indicated for PD-L1-positive metastatic disease, with a significant improvement in progression-free survival (PFS) and overall survival (OS) in patients with PD-L1-expressing tumors 1.
- Urothelial carcinoma: first-line pembrolizumab or atezolizumab is recommended for cisplatin-ineligible patients with PD-L1-positive tumors.
- Head and neck squamous cell carcinoma: pembrolizumab monotherapy is preferred for recurrent/metastatic disease with PD-L1 Combined Positive Score ≥1.
- Esophageal squamous cell carcinoma: patients with PD-L1 Combined Positive Score ≥10 may receive pembrolizumab as first-line therapy.
- Cervical cancer: pembrolizumab is indicated for recurrent or metastatic disease with PD-L1 Combined Positive Score ≥1.
Importance of PD-L1 Testing
PD-L1 testing helps identify patients most likely to benefit from immune checkpoint inhibitors by measuring tumor expression of this protein, which cancer cells use to evade immune detection. Higher PD-L1 expression generally correlates with better response to these therapies, though responses vary by cancer type and individual factors 1.
Key Considerations
- PD-L1 expression is a more useful immune biomarker than tumor mutational burden (TMB) for deciding how to use immunotherapy, due to faster test results, less tissue required, and relative reproducibility across platforms and individuals 1.
- The NCCN Guidelines recommend PD-L1 testing for patients with NSCLC, triple-negative breast cancer, and other cancer types, to guide immunotherapy decisions 1.
From the FDA Drug Label
Patients were enrolled regardless of their tumor PD-L1 status Stratification factors for randomization were tumor PD-L1 expression level (≥1% versus <1% or non-quantifiable) 57% had tumors with PD-L1 expression ≥1% and 37% had tumors with PD-L1 expression that was <1%
Measuring PD-L1 expression impacts management with immunotherapy in Non-Small Cell Lung Cancer (NSCLC), specifically:
- Metastatic or Recurrent NSCLC: First-line treatment in combination with ipilimumab and platinum-doublet chemotherapy
- Metastatic Squamous NSCLC: Second-line treatment 2
From the Research
Types of Cancer where PD-L1 Expression Impacts Management with Immunotherapy
- Non-small cell lung cancer: Measuring PD-L1 expression is used to guide treatment decisions with immunotherapy, as patients with high PD-L1 expression tend to have better response rates and overall survival with PD-1/PD-L1 blockade therapy 3, 4, 5, 6, 7
- Melanoma: PD-L1 expression is used as a predictive marker for immunotherapy, with clinical trials showing efficacy of PD-1/PD-L1 checkpoint inhibitors in patients with melanoma 3
- Head and neck carcinoma: PD-L1 testing is explored as a potential biomarker to predict response to immunotherapy, with studies discussing the implementation and interpretation of PD-L1 testing in this tumor type 3
- Triple negative breast carcinoma: PD-L1 expression is evaluated as a potential biomarker for immunotherapy, with studies discussing the role of PD-L1 testing in guiding treatment decisions 3
- Renal cell carcinoma: PD-L1 testing is used to guide treatment decisions with immunotherapy, with studies discussing the efficacy of PD-1/PD-L1 checkpoint inhibitors in patients with renal cell carcinoma 3
- Urothelial carcinoma: PD-L1 expression is used as a predictive marker for immunotherapy, with studies discussing the role of PD-L1 testing in guiding treatment decisions 3
- Gastric and gastroesophageal carcinoma: PD-L1 testing is explored as a potential biomarker to predict response to immunotherapy, with studies discussing the implementation and interpretation of PD-L1 testing in this tumor type 3
- Colorectal carcinoma: PD-L1 expression is evaluated as a potential biomarker for immunotherapy, with studies discussing the role of PD-L1 testing in guiding treatment decisions 3
- Hepatocellular carcinoma: PD-L1 testing is used to guide treatment decisions with immunotherapy, with studies discussing the efficacy of PD-1/PD-L1 checkpoint inhibitors in patients with hepatocellular carcinoma 3
- Endometrial carcinoma: PD-L1 expression is used as a predictive marker for immunotherapy, with studies discussing the role of PD-L1 testing in guiding treatment decisions 3