Biomarker Testing in Lung Cancer—What Does It Mean?
Menée aux Etats-Unis à partir de données médicales portant sur 45 631 patients atteints d'un cancer du poumon non à petites cellules de stade avancé diagnostiqué entre 2011 et 2018 (âge moyen : 68,4 ans), cette étude analyse l'évolution de l'utilisation des tests mesurant l'expression intratumorale de PD-L1 avant et après l'autorisation par la FDA du pembrolizumab en traitement de première ligne (année 2016), puis évalue sur la période 2016-2018 l'association entre l'utilisation des tests PD-L1 et l'utilisation des inhibiteurs de point de contrôle immunitaire
The study by Leapman and colleagues presents the results of an analysis of the Flatiron Health Database concentrating on the use of programmed cell death ligand 1 (PD-L1) testing and immune checkpoint inhibitors (ICIs) in patients with previously untreated, metastatic non–small cell lung cancer (NSCLC). The good news is that there has been rapid uptake of testing and use of ICIs in the appropriate population. Furthermore, as studies have been reported that expanded the indication for treatment with ICIs, practitioners quickly adopted these new approaches, frequently ahead of regulatory authorities. The bad news is that enthusiasm for these agents also led to overuse, in that a substantial proportion of patients whose PD-L1 status was less than 1 or who were untested received single-agent pembrolizumab, despite evidence that the drug was less effective than standard chemotherapy in this population.
JAMA Network Open , éditorial en libre accès, 2019