Expression of Immune Response Markers in Arab Patients With Lung Cancer

Abstract

PURPOSE Programmed death-ligand 1 (PD-L1) is a marker for checkpoint inhibitor use in the management of solid tumors, especially in non–small-cell lung cancer (NSCLC). Our study was aimed at determining the patterns of PD-L1 expression and cluster of differentiation 8 (CD8) immunostains in patients with NSCLC in the Arab population. METHODS Archival tumor tissue from patients with a confirmed diagnosis of NSCLC were obtained and stained for PD-L1 with antibody 22C3, using immunohistochemistry staining and giving the tumor proportion score (TPS) as a percentage from 0%-100% of stained tumor cells. Tumors were categorized into negative expressers (TPS < 1%), low positive (TPS, 1%-49%), and high positive (TPS, 50%-100%). Correlation of expression with clinical and pathologic features, including CD8-positive (CD8+) lymphocyte density, was also analyzed. RESULTS Two hundred patients with NSCLC were included in the study from 6 centers in Saudi Arabia and Algeria. Median age was 65 years (28-93 years), and the majority were men (75%) with stage 4 NSCLC (64%). The TPS was high in 37 patients (18%), low in 60 patients (30%), and negative in 103 patients (52%). In a univariate analysis, the following were significant predictors of any PD-L1 expression (> 1%): male sex, being Saudi national patients, high expression of CD8+, and presence of tumor-infiltrating lymphocytes. In the multivariate analysis, only high expression of CD8+ cells (≥ 2+) was significant, with an odds ratio of 4.4 (95% CI, 1.5 to 12.9; P = .003) CONCLUSION PD-L1 expression in our population is similar to the published literature and correlated with the density of CD8+ cells. Validation of the predictive value of this marker in our population and identifying easier and reliable methods to test for it are warranted.

A retrospective, descriptive analysis identifying non‑small cell lung cancer molecular markers

“…The present study revealed that PD-L1 expression was present in 24.7% of the patients. The prevalence of PD-L1 expression in the present study was similar to data published in the only other study examining PD-L1 expression from our region ( 19 ); however, both studies are corroborated by Dietel et al ( 20 ) in their large multicentre study investigating PD-L1 expression in 18 different countries. PD-L1 positivity did not show a significant association with smoking status, as 27 out of 69 PD-L1-positive patients were non-smokers.…”

Beyond clinical trials: real-world impact of immunotherapy on NSCLC in Jordan

“…Consequently, evaluating PD-L1 expression levels in advanced-stage NSCLC has become a critical aspect of treatment planning. The PD-L1 expression in a lung cancer patient population from the Middle East was found to be similar to published literature ( 10 ).…”

Epidemiological and clinicopathological features of lung cancer in Algeria

“…Besides, EGFR and PDL1 have been proved as predictive biomarkers for tyrosine kinase and PD1/PDL1 inhibitors, respectively, in advanced NSCLC [37,38]. In conjunction with the higher incidence of ADC in the current study, high rates of EGFR mutation and PDL1 overexpression (about 40%) were observed in our patients with NSCLC, in particular in those with ADC [39,40]. This suggests that a large volume of Algerian patients with lung cancer are likely candidates for EGFR-targeted therapy and PD1/PDL1 immunotherapy.…”