Dr. Gandara on the Utility of TMB in NSCLC

David R. Gandara, MD, director, Thoracic Oncology Program, professor, senior advisor to director, UC Davis Comprehensive Cancer Center, and a 2017 Giant of Cancer Care^® in Lung Cancer, discusses the utility of tumor mutational burden (TMB) in non–small cell lung cancer (NSCLC).

​Along with PD-L1​, recent data suggest that TMB is another predictive biomarker for checkpoint inhibitors, says Gandara. However, TMB varies significantly between different cancer types and within individual patients, making TMB a complex biomarker.

​Recently, pembrolizumab (Keytruda) received its second biomarker-based indication from the FDA for adult and pediatric patients with unresectable or metastatic TMB-high solid tumors. According to Gandara, while this approval is a step forward in this space, it raises questions that need to be answered.

Notably, NSCLC is associated with a high mutational burden compared with other cancers as many patients were former smokers. As such, TMB may have many implications regarding the use of immunotherapy in NSCLC, Gandara concludes.