PD-L1 Score Demonstrates Value as Prognostic Biomarker in Early-Stage EGFR-Mutated Non-Small Cell Lung Cancer

Findings from a study in Singapore suggest programmed death ligand 1 (PD-L1) scores exhibit prognostic efficacy in predicting overall survival (OS) and disease-free survival (DFS) in patients with early-stage epidermal growth factor receptor (EFGR)-mutated non-small cell lung cancer (NSCLC).

“The clinical significance of PD-L1 score among oncogene-driven NSCLC remains poorly defined,” wrote Stephanie Saw, MRCP, MMed, National Cancer Centre Singapore, Singapore, and co-authors.

The study included 455 patients, classified as either EGFR-mutated (n = 267) or EGFR-wildtype (n = 188). 121 patients (45.3%) with EGFR-mutated NSCLC and 103 patients with EGFR-wildtype (54.8%) had PD-L1 ≥1 % (P = .047).

After a median follow-up of 47 months, 2-year DFS and 5-year OS in patients with EGFR-mutant NSCLC and PD-L1 <1% was 78.1% and 59.5%, respectively. Among patients with EFGR-mutant NSCLC and PD-L1 ≥1%, 2-year PFS was 67.6% (P = .007) and 5-year OS was 42.9% (P = .001). After controlling for age, gender, lymphovascular invasion, adjuvant therapy and resection margin status, the study found PD-L1 ≥1%, to be an independent predictor of inferior OS (hazard ratio [HR] 2.18; 95% confidence interval [CI], 1.04 to 4.54; P = .038). Cancer at stages IIB (HR 7.78; 95% CI, 1.72 to 35.27; P = .008) and IIIA (HR 4.45; 95% CI, 1.44 to 13.80; P = .01) were also associated with worse OS.

Additionally, an exploratory genomic analysis of 81 EGFR-mutated tumors found PD-L1 ≥1% tumors yielded significantly higher rates of TP53 mutations than PD-L1 <1% tumors (36.1% vs 15.6%; P = .04), with missense mutations predominating.

Dr Saw, et al concluded, “PD-L1 ≥1% is an independent predictor of worse OS among early-stage EGFR-mutated NSCLC and is associated with inferior DFS regardless of EGFR status. PD-L1 score as a risk stratification factor should be evaluated in prospective adjuvant studies among EGFR-mutated NSCLC.”

Source:

Saw SPL, Ng WP, Zhou S, et al. PD-L1 score as a prognostic biomarker in Asian early-stage epidermal growth factor receptor-mutated lung cancer. Eur J Cancer. 2023;178:139-149. doi:10.1016/j.ejca.2022.10.012