Frontiers in Oncology (Jan 2024)

Redetermination of PD-L1 expression after chemio-radiation in locally advanced PDL1 negative NSCLC patients: retrospective multicentric analysis

  • Patrizia Ciammella,
  • Salvatore Cozzi,
  • Paolo Borghetti,
  • Marco Galaverni,
  • Valerio Nardone,
  • Maria Paola Ruggieri,
  • Matteo Sepulcri,
  • Vieri Scotti,
  • Alessio Bruni,
  • Francesca Zanelli,
  • Roberto Piro,
  • Elena Tagliavini,
  • Andrea Botti,
  • Federico Iori,
  • Federico Iori,
  • Emanuele Alì,
  • Chiara Bennati,
  • Marcello Tiseo

DOI
https://doi.org/10.3389/fonc.2024.1325249
Journal volume & issue
Vol. 14

Abstract

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BackgroundChemoradiation therapy (CRT) is the treatment of choice for locally advanced non-small cell lung cancer (LA-NSCLC). Several clinical trials that combine programmed cell death 1 (PD1) axis inhibitors with radiotherapy are in development for patients with LA-NSCLC. However, the effect of CRT on tumor cells programmed cell death ligand-1 (PD-L1) expression is unknown.MethodsIn this multicentric retrospective study, we analyzed paired NSCLC specimens that had been obtained pre- and post-CRT. PD-L1 expression on tumor cells was studied by immunohistochemistry. The purpose of this study was to evaluate the feasibility, risk of complications, and clinical relevance of performing re-biopsy after CRT in patients with PD-L1 negative LA-NSCLC.ResultsOverall, 31 patients from 6 centers with PD-L1 negative LA-NSCLC were analyzed. The percentage of tumor cells with PD-L1 expression significantly increased between pre- and post-CRT specimens in 14 patients (45%). Nine patients had unchanged PD-L1 expression after CRT, in five patients the rebiopsy material was insufficient for PD-L1 analysis and in two patients no tumor cells at rebiopsy were found. The post-rebiopsy complication rate was very low (6%). All patients with positive PD-L1 re-biopsy received Durvalumab maintenance after CRT, except one patient who had a long hospitalization for tuberculosis reactivation. Median PFS of patients with unchanged or increased PD-L1 expression was 10 and 16.9 months, respectively.ConclusionCRT administration can induce PD-L1 expression in a considerable fraction of PD-L1 negative patients at baseline, allowing them receiving the maintenance Durvalumab in Europe. Hence, after a definitive CRT, PD-L1 redetermination should be considered in patients with LA-NSCLC PD-L1 negative, to have a better selection of maintenance Durvalumab candidates.

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