PD-L1 testing for lung cancer in the UK: recognizing the challenges for implementation.
File(s)Cree_et_al-2016-Histopathology.pdf (798.01 KB)
Published version
Author(s)
Type
Journal Article
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.
Date Issued
2016-06-30
Date Acceptance
2016-05-19
Citation
Histopathology, 2016, 69 (2), pp.177-186
ISSN
1365-2559
Publisher
Wiley
Start Page
177
End Page
186
Journal / Book Title
Histopathology
Volume
69
Issue
2
Copyright Statement
© 2016 The Authors. Histopathology published by John Wiley & Sons Ltd.This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use anddistribution in any medium, provided the original work is properly cited, the use is non-comm ercial and no modifications or adaptations are made
Subjects
immunohistochemistry
immunotherapy
non-small-cell lung cancer
programmed death ligand 1
programmed death receptor 1
quality assurance
specimen handling
treatment stratification
Publication Status
Published