Department of Pathology, Toranomon Hospital, Tokyo, Japan.
Department of Pathology, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street, Warren 122, Boston, MA, 02114, USA.
Virchows Arch. 2021 Jan;478(1):31-44. doi: 10.1007/s00428-021-03030-8. Epub 2021 Jan 24.
Immune checkpoint inhibitor (ICI) therapies, including the programmed cell death protein 1 (PD-1) axis blockade, are considered a major oncological breakthrough of the early twenty-first century and have led to remarkable response rates and survival in a subset of patients with non-small cell lung cancer (NSCLC). However, the available therapies work only for one in five unselected, advanced NSCLC patients; thus, patient selection needs to be performed with the use of efficient biomarkers. Although imperfect, programmed death-ligand 1 (PD-L1) expression by immunohistochemistry (IHC) on tumor cells and/or immune cells has been established as a predictive biomarker for response to the PD-1 axis blockade. There remain several pre-analytical, analytical, and post-analytical issues, however, before implementing a PD-L1 IHC assay(s) in the pathology laboratory. In addition, given the lack of robust sensitivity and specificity of PD-L1 IHC for predicting response to ICIs, other biomarkers including tumor mutation burden (TMB) are under investigation. In this review, issues associated with PD-L1 IHC and TMB estimations will be discussed, and other promising biomarkers for predicting response to ICIs will be briefly introduced.
免疫检查点抑制剂(ICI)治疗,包括程序性死亡蛋白 1(PD-1)轴阻断,被认为是 21 世纪早期的一个重大肿瘤学突破,并导致了一部分非小细胞肺癌(NSCLC)患者显著的反应率和生存率。然而,现有的治疗方法仅适用于五分之一未经选择的晚期 NSCLC 患者;因此,需要使用有效的生物标志物进行患者选择。尽管并不完美,但肿瘤细胞和/或免疫细胞的程序性死亡配体 1(PD-L1)表达的免疫组织化学(IHC)已被确立为预测 PD-1 轴阻断反应的生物标志物。然而,在病理实验室中实施 PD-L1 IHC 检测之前,仍然存在一些分析前、分析中和分析后的问题。此外,鉴于 PD-L1 IHC 预测对 ICI 反应的敏感性和特异性不足,包括肿瘤突变负荷(TMB)在内的其他生物标志物正在研究中。在这篇综述中,将讨论与 PD-L1 IHC 和 TMB 估计相关的问题,并简要介绍其他预测对 ICI 反应的有前途的生物标志物。
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