Operationalizing Screening for Non-Small Cell Lung Cancer: An International Discussion - Episode 7
PD-L1 Testing in NSCLC: A Practical Guide for Oncologists
Experts discuss the practical use and limitations of PD-L1 testing in NSCLC. They confirm that testing is standard for all patients, but note results can vary between different PD-L1 test platforms, requiring quality-controlled assays.
A critical point addressed is how to manage conflicting results. The panel strongly advises that when an actionable driver mutation like an ALK fusion is present, treatment must be guided by the driver, not the PD-L1 expression. They emphasize that immunotherapy is ineffective in these patients, even with high PD-L1 levels.
The conversation then tackles the controversial use of consolidation immunotherapy after chemoradiation (PACIFIC regimen) in PD-L1 negative patients. While approved in the US, data suggests a potential survival detriment. One expert shares his practice of being transparent with patients, stating that the risk of side effects may outweigh the unproven overall survival benefit in this subgroup, highlighting that overall survival remains the most important endpoint in curative-intent settings.
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