Mesothelioma is thought to be an immunogenic tumor, with upregulation of PD-L1, says Anne S. Tsao, MD. To explore this further, SWOG and The Hope Foundation have undertaken data collection for a large international tumor registry to assess whether PD-L1 is expressed in tumor cells or in tumor-infiltrating lymphocytes in both salvage and neoadjuvant settings.

Similar global initiatives are being established for patients with thymic malignancies, where immunotherapy is also thought to be active in these diseases, adds Heather A. Wakelee, MD. Applying immunotherapy with checkpoint inhibitors will first focus on thymic carcinomas and may expand cautiously into thymomas without an autoimmune origin, adds Wakelee.

Immunotherapy is effective in approximately 20% to 25% of individuals with non-small cell lung cancer. Developing strategies to target and overcome resistance should be given major attention in clinical trials, states Roy S. Herbst, MD, as disease resistance presents a great challenge to effective treatment. A more efficient use of biopsies, says Thomas E. Stinchcombe, MD, will promote better disease management as well, and liquid biopsies may serve as a promising avenue for early detection of resistance.

Tsao highlights the importance of enrolling patients into clinical trials, noting that lung cancer is not a single disease but rather hundreds of diseases with various molecular subtypes. It is also crucial to screen individuals for adenocarcinoma, squamous cell carcinoma, and neuroendocrine types of malignancies.