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  • Michael Misialek, MD

A Trifecta for Immunotherapy in Lung Cancer


This week the American Association for Cancer Research annual meeting has brought a trifecta of groundbreaking news for immunotherapy in lung cancer. Blockade of the PD-1/PD-L1 pathway, which results in the release of the immune system “brakes” and a powerful T cell response against cancer, is reaching its full potential in lung cancer.

These 3 studies found the following:

"Neoadjuvant nivolumab was associated with few side effects, did not delay surgery, and induced a major pathological response in 45% of resected tumors. The tumor mutational burden was predictive of the pathological response to PD-1 blockade. Treatment induced expansion of mutation-associated, neoantigen-specific T-cell clones in peripheral blood."

"Progression-free survival was significantly longer with first-line nivolumab plus ipili-mumab than with chemotherapy among patients with NSCLC and a high tumor mutational burden, irrespective of PD-L1 expression level. The results validate the benefit of nivolumab plus ipilimumab in NSCLC and the role of tumor mutational burden as a biomarker for patient selection."

"In patients with previously untreated metastatic nonsquamous NSCLC without EGFR or ALK mutations, the addition of pembrolizumab to standard chemotherapy of pemetrexed and a platinum-based drug resulted in significantly longer overall survival and progression-free survival than chemotherapy alone."

Pathologist’s role

Pathologists are crucial in this new cancer battle. They are involved in each step of the process. First, a tumor may be biopsied in either the operating room or radiology under CAT scan guidance. Pathologists are called upon to assess the sample, ensuring it is adequate for both diagnosis and testing for precision medicine targets (“actionable mutations”).

In the lab, pathologists examine tissues under the microscope using various stains to make a diagnosis. When appropriate, a tumor is tested for the presence of “actionable mutations”. If discovered, the patient may be eligible for targeted therapy. The success of precision medicine depends on pathologists.

Follow Path Report for breaking cancer news and to learn how pathologists are crucial members of the care team.

#lung #cancer #immunotherapy #PDL1

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