Highlights
- •Pulmonary pleomorphic carcinomas (PCs) are known to express a high level of PD-L1.
- •Given its poor prognosis, the role of PD-L1 in PCs warrants further investigation.
- •In this study, 89.6% were PD-L1 positive (≥1%) and 80.0% had high PD-L1 expression.
- •Immunotherapy showed ORR 49%, mPFS 7.2 months and mOS 22.2 months.
- •High PD-L1 expression group showed longer PFS (7.2 versus 1.5) and OS (22.2 versus 3.5).
Abstract
Background
We evaluated programmed death ligand 1 (PD-L1) expression and efficacy of PD-1/PD-L1
inhibitors in patients with pulmonary pleomorphic carcinoma (PC).
Methods
We created two cohorts of patients diagnosed with pulmonary PC from 2016 to 2019,
PD-L1 expression and programmed death 1 (PD-1)/PD-L1 inhibitor efficacy cohorts. The
PD-L1 expression cohort included all patients evaluated for PD-L1 expression, irrespective
of PD-1/PD-L1 inhibitor therapy. High PD-L1 expression was defined as ≥50% positive
tumour cells (TC) for 22C3, ≥25% for SP263 or ≥10%/5% TC/immune cell (IC) for SP142.
The PD-1/PD-L1 efficacy cohort included patients treated with PD-1/PD-L1 inhibitors,
irrespective of PD-L1 tests.
Results
One hundred twenty-five of 175 patients diagnosed with pulmonary PCs were included
in the PD-L1 expression cohort. Among them, 112 patients (89.6%) had PD-L1-positive
(≥1%) tumours and 100 (80.0%) had tumours with high PD-L1 expression. A total of 49
patients were included in the efficacy cohort: 40 received pembrolizumab, 7 nivolumab
and 2 atezolizumab. The objective response rate was 49.0%, with a median progression-free
survival (PFS) of 7.2 months and a median overall survival of 22.2 months. In the
efficacy cohort, high PD-L1 expression (n = 41) was associated with longer PFS (median: 7.2 versus 1.5 months, hazard ratio
[HR]: 0.53 [0.22–1.29], p = 0.16) and overall survival (median: 22.2 versus 3.5, HR: 0.21 [0.08–0.57], p = 0.001) than low/negative/unknown PD-L1 expression (n = 8).
Conclusion
PD-1/PD-L1 inhibitors show outstanding efficacy for pulmonary PCs, and this is possibly
attributable to high PD-L1 expression in these tumours.
Keywords
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Article info
Publication history
Published online: May 03, 2020
Accepted:
March 23,
2020
Received:
March 20,
2020
Identification
Copyright
© 2020 Elsevier Ltd. All rights reserved.
