Abstract
BACKGROUND: Programmed cell death ligand-1 (PD-L1) is a useful biomarker in non-small cell lung cancer (NSCLC) patients who would probably benefit from immunotherapy. In most patients with advanced stage NSCLC, only small biopsy specimens were available for the evaluation of PD-L1 expression. In this study, we evaluated the feasibility and reliability of PD-L1 testing on small biopsy samples. METHODS: Small specimens of advanced NSCLC patients obtained via endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA), endobronchial biopsy (EBB), or computed tomography (CT)-guided core-needle biopsy were collected. Tumor cell count and tissue sufficiency for PD-L1 immunohistochemistry (IHC) were evaluated and compared. The clinical course of patients who received immunotherapy in the study population was also examined. RESULTS: Tissue acquisitions for PD-L1 testing in three groups were all above 90%, with no statistically significant differences. The PD-L1 expressions levels were concordant in most patients with more than one sample (8/11). In the EBB group, PD-L1-positive patients had higher objective response rate (ORR) (53.2% vs. 26.9%, p = 0.048) and longer progression-free survival (PFS) (312 vs. 179 days, p = 0.035) than PD-L1 negative patients. In the core needle biopsy group, patients with positive PD-L1 expression also trended to have higher ORR and longer PFS. However, in the EBUS-TBNA group, both ORR and PFS were similar between patients with positive or negative PD-L1 expression. CONCLUSIONS: This study showed that EBUS-TBNA, EBB, and core needle biopsy provides adequate samples for PD-L1 testing. The predictive value of PD-L1 expression on different small samples still warrants further studies.