PD-L1 Expression and Outcome in Patients with Metastatic Non-Small Cell Lung Cancer and EGFR Mutations Receiving EGFR-TKI as Frontline Treatment
Received 27 November 2020
Accepted for publication 7 January 2021
Published 31 March 2021 Volume 2021:14 Pages 2301—2309
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 2
Editor who approved publication: Dr Sanjeev Srivastava
Cheng-Yu Chang,1,* Yi-Chun Lai,2,3,* Yu-Feng Wei,4,5,* Chung-Yu Chen,6,7,* Shih-Chieh Chang2,8
1Division of Chest Medicine, Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan; 2Division of Chest Medicine, Department of Internal Medicine, National Yang Ming Chiao Tung University Hospital, Yi-Lan, Taiwan; 3Faculty of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; 4School of Medicine for International Students, College of Medicine, I-Shou University, Kaohsiung, Taiwan; 5Department of Internal Medicine, E-Da Cancer Hospital, Kaohsiung, Taiwan; 6Department of Internal Medicine, National Taiwan University Hospital Yunlin Branch, Yunlin County, Taiwan; 7College of Medicine, National Taiwan University, Taipei, Taiwan; 8Department of Critical Care Medicine, National Yang Ming Chiao Tung University Hospital, Yi-Lan, Taiwan
*These authors contributed equally to this work
Correspondence: Shih-Chieh Chang
Division of Chest Medicine, Department of Internal Medicine, National Yang Ming Chiao Tung University Hospital, No. 169, Siaoshe Road, Yi-Lan, 260, Taiwan
Email [email protected]
Background: Epidermal growth factor receptor (EGFR) mutations are most common in Eastern Asia, and frequencies of 30– 50% have been reported. EGFR-tyrosine kinase inhibitors (TKIs) are recommended as first-line therapeutic options for non-small cell lung cancer (NSCLC) with sensitizing EGFR mutations. Several immune checkpoint inhibitors have been successful in improving the outcomes of advanced lung cancer. The expression of programmed cell death-ligand 1 (PD-L1) on tumor cells plays an important role in predicting the efficacy of programmed cell death protein 1/PD-L1 inhibitors. The role of PD-L1 expression in tumors with EGFR mutation and its influence on clinical outcomes remain controversial.
Methods: Patients with newly diagnosed metastatic NSCLC with sensitizing EGFR mutations who received the standard treatment, ie, EGFR-TKIs for mutant adenocarcinoma as the first-line treatment, were enrolled in this retrospective study. EGFR mutations and PD-L1 expression levels were detected by Cobas RT-PCR and Dako 22C3 immunohistochemistry staining, respectively.
Results: From January 2011 to February 2019, 114 patients were enrolled. The average age was 62 years (range 34– 92), and 45 (39.5%) patients were male. Among these patients, EGFR mutation analysis revealed exon 19 in-frame deletion in 55 (48.2%) patients, exon 21 L858R in 53 (46.5%) patients, and uncommon mutations in 6 (5.3%) patients. Among these patients with EGFR mutations, PD-L1 expression levels by tumor proportion score (TPS) were < 1% in 54 (46.9%) patients, 1– 49% in 50 (44.2%) patients, and ≥ 50% in 10 (8.8%) patients. All patients received EGFR-TKIs as first-line treatment, and in the Kaplan-Meier analysis, progression-free survival was not significantly different among groups with different PD-L1 expression status.
Conclusion: For patients with metastatic NSCLC and EGFR mutations, PD-L1 expression is not uncommon, but no significant influence on clinical outcomes was observed in patients receiving standard initial treatment.
Keywords: programmed death-ligand 1, epidermal growth factor receptor mutation, epidermal growth factor receptor tyrosine kinase inhibitors
This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution - Non Commercial (unported, v3.0) License. By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms.Download Article [PDF] View Full Text [HTML][Machine readable]