Opinion
Video
Metastatic NSCLC (mNSCLC) Biomarkers and Prognostic Factors Compared to Early-Stage NSCLC
Specialists review specific prognostic factors and biomarkers that help guide treatment selection for patients with metastatic NSCLC (mNSCLC) and discuss if these biomarkers differ from those observed in early-stage NSCLC.
David Carbone, MD, PhD: Let’s transition now to metastatic disease. Dr Dietrich, you mentioned a little bit earlier about tumor factors that are biomarkers to help guide treatment selection for metastatic non–small cell, including PD-L1 and the genetic biomarkers. Are they different from the ones that we use for decision making in early stage or the same?
Martin Dietrich, MD, PhD: I think their impact is amplified in early-stage disease, but I do think they play a significant role. What we’ve seen in all trials is that the typical pattern of improved responses is PD-L1–dependent, is dependent on the underlying biomarkers. I do think that we shouldn’t try to replicate the lessons from metastatic disease through clinical trials. We should just accept them as biological inert lessons that can be applied in a more prognostic way.
I would use a patient who is receiving, for the same biology, chemotherapy plus immunotherapy in the metastatic setting, I would use that in an earlier setting, but I wouldn’t necessarily make any extensions of disease. I think we’ve had inclusions of EGFR patients in some of these trials. I don’t think they belong there. I think this is a subgroup that we’ve seen in postradiation and postsurgery settings, that they don’t benefit. Yes, I do think they belong in the discussion. I think they moderate the expectations and the outlook for patients and they certainly make me think about the expectations. If I have a PD-L1–negative patient, I would consider, maybe a perioperative, rather than just a pure neoadjuvant regimen.
But the message is, every patient needs to be tested. A diagnosis of their disease, whether it is stage I or at a stage IV, the disease is guided by their biomarkers, by the intrinsic biology. It’s very helpful for us now. We used to have the hesitation from pathology that says, “Well, if we reflex test and we may get all these inappropriate rejections,” there is no more patient that it’s inappropriate for molecular testing. In my opinion, this becomes even more impactful because we’re talking here about patients with a potential for cure. This is true whether we radiate them, this is true whether we surgically approach them, systemic approaches are the ones that are shortening the patients and the outcomes. The biology and the underlying markers here really are critical for any discussion.
David Carbone, MD, PhD: We’ve incorporated the genetic and the PD-L1 markers in managing patients with metastatic disease. I think the time will come where we will use those, and it’s actually here now, use those in the earlier-stage patients. I don’t know what people’s feelings are about PD-L1–negative patients being treated with chemoradiation, or EGFR mutant and those kinds of things. But there’s more and more data now with the ADAURA trial showing survival benefit that we’re going to be incorporating the targeted therapies in earlier stages as well, adjuvant, and possibly neoadjuvant in the future.
Transcript is AI generated and reviewed by an AJMC editor.
