PDL-1 in non-small cell lung cancer (NSCLC): Association with molecular alterations and clinical outcome.

Background: The Immune checkpoint inhibitors (ICI) targeting PDL-1 show improved outcomes in lung adenocarcinoma patients. This study is intended to understand the association of PDL-1 with molecular alterations in non small cell lung cancer patients.

Aims: To correlate clinicopathological features with molecular phenotype across PDL-1 subgroups and analyze survival outcomes for patients having PDL-1 expression (>1%).

Materials and methods: We did a retrospective study of 100 NSCLC cases diagnosed at primary and metastatic sites using a next-generation sequencing (NGS) lung panel and the PDL-1 SP263 clone on the Ventana platform. PDL-1 expression, sample size, sex, histological type, and oncogenic mutation status were analyzed. Patients with PDL-1 expression >1% and managed with immunotherapy (IO), targeted therapy (TT), and conventional chemotherapy (CC) were followed up for a median time of 7 months. The outcome was assessed as overall survival (OS).

Results: Fifty-one percent of the cases showed a positive PDL-1 expression. Squamous cell carcinoma (SCC) exhibited higher PDL-1 expression than adenocarcinoma (AC) (P-value = 0.005). The KRAS expression was more frequent in males (P-value = 0.048). There was no difference between the tumor location and the type of sample used. The EGFR mutation was exclusively seen in AC compared with other NSCLCs. The median overall survival in the IO and TT groups was 13 and 11 months, respectively, compared to 7 months in the CC group.

Conclusions: Integrating clinical, molecular, and immunological data will enhance the predictive value of PDL-1 biomarkers in lung adenocarcinoma.