Schildhaus H-U
Institut für Pathologie, Universitätsmedizin Göttingen, Robert-Koch-Straße 40, 37075, Göttingen, Deutschland.
Pathologe. 2018 Nov;39(6):498-519. doi: 10.1007/s00292-018-0507-x.
Immuno-oncology related treatments have become standard of care for many tumor entities. Numerous additional indications are currently under investigation in ongoing clinical trials. Predictive biomarkers include microsatellite instability as well as tumor mutational burden. However, PD-L1 testing by immunohistochemistry (IHC) is already widely established as a biomarker in clinical routine for certain treatment decisions in non-small cell lung cancer, head and neck cancer and in urothelial carcinomas. More applications of that kind are expected to follow. Moreover, PD-L1 testing can provide clinicians with valuable information even if the test is not mandatory (i. e., complementary diagnostics). PD-L1 staining requires a highly specific staining over a broad dynamic range. Sensitive and specific primary antibodies and suitable staining protocols are prerequisite. Selection of appropriate patients' materials, validation and contiguous quality assurance need to meet the highest standards. There are different scoring algorithms for PD-L1 stainings which are specific to tumor entities and certain clinical decisions. The tumor proportion score (TPS) is a PD-L1 measurement which is applied, for example, to lung cancer, head and neck cancer and melanomas. Within this approach, only membranous staining of tumor cells is regarded as a significant staining. In contrast, the combined positivity score (CPS) and inflammatory cell (IC) scoring include or are restricted to PD-L1 expression in certain inflammatory cells, respectively. CPS and IC scoring are standard measurements of PD-L1 in urothelial carcinoma.
免疫肿瘤学相关治疗已成为许多肿瘤类型的标准治疗方法。目前,正在进行的临床试验中正在研究众多其他适应症。预测性生物标志物包括微卫星不稳定性以及肿瘤突变负荷。然而,通过免疫组织化学(IHC)检测PD-L1已在临床常规中广泛确立,作为非小细胞肺癌、头颈癌和尿路上皮癌某些治疗决策的生物标志物。预计会有更多此类应用。此外,即使检测不是强制性的(即补充诊断),PD-L1检测也可以为临床医生提供有价值的信息。PD-L1染色需要在宽动态范围内进行高度特异性染色。灵敏且特异的一抗和合适的染色方案是前提条件。选择合适的患者材料、验证以及持续的质量保证需要达到最高标准。对于PD-L1染色有不同的评分算法,这些算法特定于肿瘤类型和某些临床决策。肿瘤比例评分(TPS)是一种PD-L1测量方法,例如应用于肺癌、头颈癌和黑色素瘤。在这种方法中,只有肿瘤细胞的膜染色被视为有效染色。相比之下,联合阳性评分(CPS)和炎症细胞(IC)评分分别包括或限于某些炎症细胞中的PD-L1表达。CPS和IC评分是尿路上皮癌中PD-L1的标准测量方法。