Abstract 3065
Background
Non-small cell lung cancer (NSCLC) has the highest mortality rate of all cancers worldwide. Developments in oncological therapy have led to new therapeutic guidelines including immunotherapy such as PD-1/ PD-L1 inhibitors. However, PD-L1 expression in tumor cells might be a dynamic process explaining variability in PD-L1 expression. To test the hypothesis of PD-L1 conversion in patients presenting with NSCLC we evaluated PD-L1 expression in initial tumor samples as well as at recurrence.
Methods
We retrospectively examined PD-L1 expression in resected specimens of patients with NSCLC as well as in biopsies at recurrence by immunohistochemistry (IHC). Patients presenting NSCLC recurrence after adjuvant chemotherapy and with no adjuvant chemotherapy were included. IHC score was defined as the proportion of tumor cells with stained cell membrane. Migration of IHC group was considered as a significant change in PD-L1. Four IHC score groups were defined: TC0 <1%, TC1 ≥1 <5%, TC2 ≥5 <50% and TC3 ≥50%
Results
In total, 36 patients were included. All patients presented adenocarcinoma. 20 patients (56%) underwent adjuvant chemotherapy after surgical resection and 16 patients (44%) had no adjuvant chemotherapy. Initial PD-L1 expression was present in 10 out of 36 patients corresponding to 28%. Out of 20 patients receiving adjuvant chemotherapy 7 patients (35%) showed significant upregulation in PD-L1 expression at recurrence. In comparison to patients with no adjuvant therapy, where only 2 out of 16 (12.5%) showed significant change in PD-L1 expression. Furthermore, 6 out of 36 patients (17%) were PD-L1 negative and had become positive at NSCLC recurrence.
Conclusions
Progress in immunotherapy has led to new therapeutic guidelines. We demonstrated that chemotherapy might increase PD-L1 expression in NSCLC specimens. These findings suggest that chemotherapy in combination with immunotherapy might constitute a new therapeutic strategy for locally advanced NSCLC. Furthermore, in about 17% of our patients, the initial tumor sample proved PD-L1 negative, but a significant change in PD-L1 expression at tumor recurrence was demonstrated. This might suggest the use of PD-L1 inhibitors in first line therapy, even if PD-L1 expression is not present at time of diagnosis.
Clinical trial identification
Legal entity responsible for the study
Alessandra Curioni-Fontecedro.
Funding
Has not received any funding.
Editorial Acknowledgement
Disclosure
All authors have declared no conflicts of interest.
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