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Improvements in lung cancer treatment
S100 Utility of endobronchial ultrasound-guided transbronchial needle aspiration for pd-l1 testing in patients with nsclc
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  1. F Perrotta1,
  2. B Adizie2,
  3. U Maqsood3,
  4. M Elshafi4,
  5. S Jafri5,
  6. I Woolhouse2,
  7. M Munavvar3,
  8. M Evison4,
  9. R Booton4,
  10. DR Baldwin5,
  11. SM Janes6,1,
  12. A Bianco,
  13. N Navani6
  1. 1University of Campania “L. Vanvitelli”, Naples, Italy
  2. 2University Hospitals Birmingham , Birmingham, UK
  3. 3Lancashire Teaching Hospitals, Preston, UK
  4. 4University Hospital of South Manchester, Manchester, UK
  5. 5Nottingham University Hospitals, Nottingham, UK
  6. 6University College of London, London, UK

Abstract

Rationale Recent data have demonstrated the superiority of Pembroluzimab over chemotherapy for patients with advanced NSCLC and high (≥50% expression) of PD-L1.1 This has resulted in NICE approving Pembroluzimab as a first line treatment option for patients with advanced NSCLC in June 2017. The original trial however excluded patients with PD-L1 testing on EBUS samples. We therefore conducted a large, multicentre study to clarify whether specimens obtained by EBUS-TBNA were suitable for testing PD-L1 in patients with NSCLC.

Methods NSCLC samples acquired by EBUS-TBNA (29.4%), percutaneous biopsy (31.2%), endobronchial biopsy (13.8%), surgical (21.4%) or other techniques (4.1%) were recorded from 435 consecutive patients with known or suspected lung cancer across 5 centres in England between January 2015 and December 2016.

Results PD-L1 assessment (using the 22 C3 assay in all cases) was possible in 92.2% of patients undergoing EBUS and there was no difference in success of PD-L1 testing according to modality of tissue acquisition (p=0.18). The frequency of complications from EBUS-TBNA was similar to endobronchial or percutaneous techniques but lower than surgical procedures (5.0% vs 13.8%; p=0.03). PD-L1 expression in the cohort was high (≥50%) in 28.5%, weak (≥1%–50%) in 28.2%, whilst 43.3% of patients were PD-L1 negative. The only statistically significant predictor for PD-L1 expression in multivariate analysis was the presence of brain metastasis at diagnosis (OR 2.02; CI 1.04–3.90). 47 patients (11.4%) were treated with immunotherapy and the response rate was 16.2%. All patients that responded to immunotherapy had high (≥50%) expression of PD-L1.

Conclusions This large multicentre study demonstrates for the first time that samples obtained by EBUS-TBNA in routine practice are suitable for PD-L1 testing in patients with NSCLC. The presence of brain metastases at diagnosis predicts high PD-L1 expression in this cohort and this new finding should be tested in future clinical trials.

Reference

  1. Reck M, Rodrguez-Abreu D, Robinson AG, et al. Pembrolizumab versus Chemotherapy for PD-L1Positive NonSmall-Cell Lung Cancer. N Engl J Med 2016;375(19):1823-33. doi:10.1056/NEJMoa1606774

https://doi.org/10.1136/thoraxjnl-2017-210983.106

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