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9.07.2017

Sylvester Researcher Identifies Tumor Biomarker to Guide Lung Cancer Immunotherapy

A predictive tumor biomarker can help clinicians identify lung cancer patients who are most likely to benefit from immunotherapy, according to a researcher at the Sylvester Comprehensive Cancer Center at the University of Miami Miller School of Medicine.

“Immunotherapy for patients with metastatic non–small cell lung cancer (NSCLC) who have failed chemotherapy can extend their lives,” said Gilberto de Lima Lopes, Jr., M.D., M.B.A., associate professor of clinical medicine, Medical Director for International Programs, and Associate Director of Global Oncology. “Patients who test positive for a predictive biomarker called PD-L1 may have the greatest potential benefit in terms of outcomes. However, these medications are very expensive and not all NSCLC patients respond to this treatment.”

Lopes was lead author of a collaborative international study, “The Effect of PD-L1 Testing on the Cost-Effectiveness and Economic Impact of Immune Checkpoint Inhibitors for the Second-Line Treatment of NSCLC,” that was published recently in Annals of Oncology. The co-authors were cancer researchers from Brazil, Australia, Portugal and Scottsdale, Arizona.

The American Cancer Society (ACS) estimates that there will be about 222,500 new cases of lung cancer (both small cell and non-small cell) and about 155,870 deaths in 2017. Each year, more people die of lung cancer than of colon, breast and prostate cancers combined, according to the ACS.

In May, the National Comprehensive Cancer Network (NCCN) updated its guidelines for the management of advanced NSCLC to call for routine molecular analysis and testing for PD-L1 expression, preferably at diagnosis. The guidelines recommend that PD-L1, in addition to molecular analysis, be employed as a biomarker to direct initial therapy.

“Immunotherapy is one of our new hopes in oncology,” Lopes said. “Many lung cancer patients have responded well to three medications — nivolumab, pembrolizumab, and atezolizumab — and lived longer.”

The study’s objective was to assess the effectiveness of follow-up cancer treatment using the three medications with and without PD-L1 testing for patient selection, Lopes said.

Compared with treating all patients, the selection of patients by PD-L1 expression improved their incremental quality-adjusted life years (QALY) by up to 183 percent.

Lopes then compared the cost-effectiveness of PD-L1 assessment and second-line immunotherapy versus standard chemotherapy with docetaxel. Using outcome data from randomized clinical trials and drug acquisition costs from the United States, he found that the use of PD-L1 expression as a biomarker increased the cost-effectiveness of immunotherapy. However, it also diminished the total number of potential life-years saved, since not all patients would receive the immunotherapy medications.

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