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Hempenius MA, Koomen BM, Deckers IAG, Oosting SF, Willems SM, van der Vegt B. Considerable interlaboratory variation in PD-L1 positivity for head and neck squamous cell carcinoma in the Netherlands- A nationwide evaluation study. Histopathology 2024; 85:133-142. [PMID: 38606992 DOI: 10.1111/his.15184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 03/11/2024] [Accepted: 03/16/2024] [Indexed: 04/13/2024]
Abstract
AIMS Patients with recurrent or metastatic head and neck squamous cell carcinoma (HNSCC) are eligible for first-line immune checkpoint inhibition if their tumour is positive for programmed death ligand 1 (PD-L1) determined by the combined positive score (CPS). This nationwide study, using real-world data, investigated the developing PD-L1 testing landscape in the first 3 years after introduction of the test in HNSCC and examined interlaboratory variation in PD-L1 positivity rates. METHODS Pathology reports of HNSCC patients mentioning PD-L1 were extracted from the Dutch Pathology Registry (Palga). Tumour and PD-L1 testing characteristics were analysed per year and interlaboratory variation in PD-L1 positivity rates was assessed using funnel plots with 95% confidence limits around the overall mean. RESULTS A total of 817 PD-L1 tests were reported in 702 patients among 19 laboratories; 85.2% of the tests on histological material were stated to be positive. The national PD-L1 positivity rate differed significantly per year during the study period (79.7-89.9%). The use of the recommended 22C3 antibody increased from 59.9 to 74.3%. A total of 673 PD-L1 tests on histological material from 12 laboratories were analysed to investigate interlaboratory variation. Four (33%) deviated significantly from the national mean of PD-L1-positive cases using CPS ≥ 1 cut-off, while two (17%) deviated significantly for CPS ≥ 20 cut-off. CONCLUSION In the first 3 years of PD-L1 assessment in HNSCC, the testing landscape became more uniform. However, interlaboratory variation in PD-L1 positivity rates between Dutch laboratories was substantial. This implies that there is a need for further test standardisation to reduce this variation.
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Affiliation(s)
- Maaike Anna Hempenius
- Department of Pathology and Medical Biology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Bregje M Koomen
- Department of Pathology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | | | - Sjoukje F Oosting
- Department of Medical Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Stefan M Willems
- Department of Pathology and Medical Biology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Bert van der Vegt
- Department of Pathology and Medical Biology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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2
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Kholová I, Chandra A, Faquin WC, Rupp NJ, Touska P, O'Regan E. Updates in head and neck cytopathology: Insights from European Congress of Pathology Short Course. Cytopathology 2024; 35:344-349. [PMID: 38351503 DOI: 10.1111/cyt.13368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2024] [Accepted: 02/04/2024] [Indexed: 02/20/2024]
Abstract
Cytological specimens play a pivotal role in head and neck nodule/mass work up and diagnoses. The specimens´ importance has grown with the onset of personalized medicine and the routine use of molecular markers in the diagnostic work up. The Updates in Head and Neck Cytopathology Short Course ran during the 35th European Congress of Pathology held in Dublin, Ireland, in 2023 and brought together experts in cytopathology, pathology, and related fields to share their expertise and experience in the field of head and neck cytopathology and its future directions. Topics such as a one-stop clinic, the Milan System for Reporting Salivary Gland Cytopathology, next generation sequencing, and human papilloma virus detection in the head and neck area were covered during the short course. These topics are briefly summarized in the present review.
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Affiliation(s)
- Ivana Kholová
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Pathology, Fimlab Laboratories, Tampere, Finland
| | | | - William C Faquin
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Niels J Rupp
- Department of Pathology and Molecular Pathology, University Hospital Zurich, Zurich, Switzerland
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Philip Touska
- Department of Radiology, Guy's and St Thomas' Hospital NHS Foundation Trust, London, UK
| | - Esther O'Regan
- Department of Histopathology, St. James's Hospital & Dublin Dental Hospital, Trinity College Dublin, Dublin, Ireland
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3
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Li JJX, Tse GM. Immunocytochemical markers, molecular testing and digital cytopathology for aspiration cytology of metastatic breast carcinoma. Cytopathology 2024; 35:218-225. [PMID: 37985397 DOI: 10.1111/cyt.13333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 08/28/2023] [Accepted: 11/02/2023] [Indexed: 11/22/2023]
Abstract
Fine-needle aspiration cytology (FNAC) is a versatile diagnostic procedure uniquely suited for tissue biopsy of breast carcinomas and axillary metastases and/or recurrences. With the expanding treatment options and accompanying theragnostic tests, it is crucial to recognize the developments on ancillary testing and digital cytopathology techniques related to aspiration cytology of metastatic breast carcinoma. In this review, we aim to summarize and update the evidence of immunocytochemistry, for the detection of carcinoma cells (epithelial markers), confirmation of breast primary (breast-specific markers), assessment of surrogate immunostains (hormone receptors, ki-67 proliferative index and HER2) and theragnostic biomarkers, with discussion on potential diagnostic pitfalls, followed by the application of molecular tests, and digital cytopathologic techniques for assessing metastatic breast carcinoma in cytology.
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Affiliation(s)
- Joshua J X Li
- Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Gary M Tse
- Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
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4
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Lou SSK, Ruff H, MacDonald S, Smith SM, Cheung CC. PD-L1 expression in fine-needle aspiration cell blocks of head and neck squamous-cell carcinoma and its cytohistological concordance. Diagn Cytopathol 2024; 52:163-170. [PMID: 38095142 DOI: 10.1002/dc.25264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 11/25/2023] [Accepted: 11/27/2023] [Indexed: 02/07/2024]
Abstract
BACKGROUND PD-L1 immunoexpression in head and neck squamous-cell carcinoma (HNSCC) determines immunotherapy eligibility. Patients are often diagnosed using fine-needle aspiration (FNA) of metastatic lymph nodes, however, the cytohistologic correlation of the combined positive score (CPS) is largely unknown. METHODS This study retrospectively identified 96 paired histologic (HS) and cytologic specimens (CyS), between 2016 and 2020, diagnosed with HNSCC. Cases with <100 tumor cells (n = 54) or missing block(s) (n = 8) were excluded. All 34 case pairs were scored with CPS using the PD-L1 22C3 pharmDx assay at clinically relevant cut-offs of <1%, 1%-19%, and ≥20% independently by three observers blinded to the case pairs (CyS with corresponding HS). RESULTS The CPS (<1/1-19/≥20) for CyS and HS were as follows: 10(29.4%)/10(29.4%)/14(41.2%) and 2(5.9%)/13(38.2%)/19(55.9%), respectively. There was fair overall cytohistologic agreement (OA) of 76.5% (k = 0.261) at the CPS cut-off of 1. The OA did not differ significantly between site-matched (n = 13) and -unmatched (n = 21) case pairs (p = .4653). CyS has a specificity and positive predictive value (PPV) of 100% but a negative predictive value (NPV) of only 20% as compared to its paired HS. CONCLUSIONS Our study demonstrates fair CPS cytohistologic correlation in HNSCC specimens using the PD-L1 IHC 22C3 pharmDx assay with high PPV but low NPV. This suggest that determining PD-L1 status in FNA specimens can play an important role in the clinical management of HNSCC patients.
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Affiliation(s)
- Sandy Si Kei Lou
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
- Division of Pathology, Laboratory Medicine Program, University Health Network, Toronto, Ontario, Canada
| | - Heather Ruff
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
- Division of Pathology, Laboratory Medicine Program, University Health Network, Toronto, Ontario, Canada
- Department of Pathology, Oregon Health Science University, Portland, Oregon, USA
| | - Scott MacDonald
- Division of Pathology, Laboratory Medicine Program, University Health Network, Toronto, Ontario, Canada
| | - Stephen M Smith
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
- Division of Pathology, Laboratory Medicine Program, University Health Network, Toronto, Ontario, Canada
| | - Carol C Cheung
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
- Division of Pathology, Laboratory Medicine Program, University Health Network, Toronto, Ontario, Canada
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5
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Bill R, Faquin WC, Pai SI. Assessing PD-L1 Expression in Head and Neck Squamous Cell Carcinoma: Trials and Tribulations. Head Neck Pathol 2023; 17:969-975. [PMID: 37930471 PMCID: PMC10739626 DOI: 10.1007/s12105-023-01590-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 10/09/2023] [Indexed: 11/07/2023]
Abstract
Immune checkpoint inhibitors have improved the outcome of patients diagnosed with inoperable recurrent or metastatic head and neck squamous cell carcinoma. However, as only a subset of head and neck cancer patients benefit from this treatment, biomarkers predicting treatment response help guide physicians in their clinical decision-making. PD-L1 expression assessed by immunohistochemistry is the single most clinically relevant biomarker predicting response to PD-1-blocking antibodies. Here, we discuss in which clinical context assessment of PD-L1 expression is instrumental for the choice of therapy, how pathologists score it, and how it affects the approval of anti-PD-1 antibodies. Furthermore, we discuss the heterogeneity of PD-L1 expression and review technical aspects of determining this prominent biomarker-knowledge that might influence clinical decision-making.
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Affiliation(s)
- Ruben Bill
- Department of Medical Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - William C Faquin
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Sara I Pai
- Department of Surgery, Yale School of Medicine, Yale University, 47 College Street, Suite 216, New Haven, CT, 06510, USA.
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6
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Lu H, Kuang D, Zhou P, Zeng J, Xia Q, Wang J, Duan P, Jiang L, Zang S, Jin Y, Jiang X, Li J, Tang W, Zhou J, Chen J, Ying J. PD-L1 expression in recurrent or metastatic head and neck squamous cell carcinoma in China (EXCEED study): a multicentre retrospective study. J Clin Pathol 2023:jcp-2023-209059. [PMID: 37968103 DOI: 10.1136/jcp-2023-209059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 10/12/2023] [Indexed: 11/17/2023]
Abstract
AIMS Programmed death-ligand 1 (PD-L1) is known to be highly expressed in various malignancies, including head and neck squamous cell carcinoma (HNSCC). We aimed to determine the prevalence of PD-L1 expression in recurrent or metastatic HNSCC (R/M HNSCC) among Chinese patients. METHODS This multicentre, retrospective analysis of data from six centres in China included patients with R/M HNSCC treated from 9 August 2021 to 28 February 2022. PD-L1 expression in tumour tissue was assessed and represented using a combined positive score (CPS). The χ2 and Cochran-Mantel-Haenszel χ2 tests were used to compare the prevalence of different PD-L1 expression statuses according to related co-variables. RESULTS For all 402 examined patients with R/M HNSCC, 168 cases (41.8%) had PD-L1 expression with a CPS ≥20, and 337 cases (83.8%) had PD-L1 expression with a CPS ≥1. Between the PD-L1 CPS ≥20 group and PD-L1 CPS <20 group, statistically significant differences were observed for variables of sex (p<0.001), smoking habit (p=0.0138 for non-smokers vs current smokers) and primary tumour site (p<0.001 for hypopharynx vs oral cavity and p=0.0304 for larynx vs oral cavity, respectively). CONCLUSION PD-L1 with CPS ≥20 was expressed in about 41.8% of cases with R/M HNSCC among Chinese patients, and PD-L1 expression was significantly associated with sex, smoking history and primary tumour site. Our findings regarding the variables related to PD-L1 expression level provide insight for clinical practice and a solid basis for future research on immunotherapy in HNSCC. TRIAL REGISTRATION NUMBER ISRCTN10570964.
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Affiliation(s)
- Haizhen Lu
- Department of Pathology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Dong Kuang
- Department of Pathology, Tongji Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, Hubei, China
| | - Ping Zhou
- Department of Pathology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Jing Zeng
- Department of Pathology, Sun Yat-Sen University Cancer Center, Guangzhou, Guangdong, China
| | - Qingxin Xia
- Department of Pathology, Henan Cancer Hospital, Zhengzhou, Henan, China
| | - Jian Wang
- Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Pei Duan
- Department of Pathology, Tongji Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, Hubei, China
| | - Lili Jiang
- Department of Pathology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Shengbing Zang
- Department of Pathology, Sun Yat-Sen University Cancer Center, Guangzhou, Guangdong, China
| | - Yiping Jin
- Department of Pathology, Henan Cancer Hospital, Zhengzhou, Henan, China
| | - Xiangnan Jiang
- Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Jielin Li
- MRL Global Medical Affairs, MSD China, Shanghai, China
| | - Wenmin Tang
- MRL Global Medical Affairs, MSD China, Shanghai, China
| | - Jiansong Zhou
- MRL Global Medical Affairs, MSD China, Shanghai, China
| | - Jihua Chen
- MRL Global Medical Affairs, MSD China, Shanghai, China
| | - Jianming Ying
- Department of Pathology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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7
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Iaccarino A, Nacchio M, Acanfora G, Pisapia P, Malapelle U, Bellevicine C, Troncone G, Vigliar E. Multiple predictive biomarker testing in melanoma: Another challenge in identifying the optimal approach on cytological samples. Cytopathology 2023; 34:198-203. [PMID: 36658094 DOI: 10.1111/cyt.13211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 01/12/2023] [Indexed: 01/21/2023]
Abstract
BACKGROUND The management of cutaneous melanoma has changed dramatically in recent years thanks to the development of tyrosine kinase and immune-checkpoint inhibitors (ICIs). Thus, multiple biomarker testing is becoming ever more important for the identification of patients who are potentially eligible for these treatments. One reliable approach to the molecular evaluation of metastatic melanoma is fine needle cytology (FNC). To examine the utility of this approach for assessing PD-L1 expression levels, we evaluated the cellular adequacy of residual cell block (CB) material from metastatic melanomas that were previously tested for BRAF and NRAS mutations. METHODS We retrieved from our internal archives a series of FNC samples of metastatic melanoma that had been subjected to molecular testing on residual CB material or a dedicated needle rinse between January 2016 and July 2022. Real-time polymerase chain reaction was used to assess BRAF and NRAS status, and an SP263 assay was employed to ascertain PD-L1 expression levels. RESULTS Overall, n = 19 cases were selected. Of these, 11 (57.9%) cases revealed a BRAF exon 15 p.V600E mutation, one case (5.3%) revealed NRAS mutation, and seven cases (36.8%) showed no mutations. Regarding PD-L1 assessment, 16/19 (84.2%) cases were deemed adequate, meaning they contained at least 100 viable cells. CONCLUSIONS We highlighted the feasibility of assessing PD-L1 expression levels in residual CB material from metastatic melanomas previously tested for BRAF and NRAS mutations. Moreover, we pointed out that FNC needle rinses may be an alternative source of nucleic acids for molecular testing, preserving CB material for immunocytochemistry evaluation.
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Affiliation(s)
- Antonino Iaccarino
- Department of Public Health, University of Naples "Federico II", Naples, Italy
| | - Mariantonia Nacchio
- Department of Public Health, University of Naples "Federico II", Naples, Italy
| | - Gennaro Acanfora
- Department of Public Health, University of Naples "Federico II", Naples, Italy
| | - Pasquale Pisapia
- Department of Public Health, University of Naples "Federico II", Naples, Italy
| | - Umberto Malapelle
- Department of Public Health, University of Naples "Federico II", Naples, Italy
| | - Claudio Bellevicine
- Department of Public Health, University of Naples "Federico II", Naples, Italy
| | - Giancarlo Troncone
- Department of Public Health, University of Naples "Federico II", Naples, Italy
| | - Elena Vigliar
- Department of Public Health, University of Naples "Federico II", Naples, Italy
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8
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Kitichotkul K, Lertprasertsuke N, Kintarak S, Pongsiriwet S, Powcharoen W, Iamaroon A. Expression of PD-L1 is HPV/P16-independent in oral squamous cell carcinoma. Heliyon 2022; 8:e10667. [PMID: 36212017 PMCID: PMC9535272 DOI: 10.1016/j.heliyon.2022.e10667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 08/09/2022] [Accepted: 09/12/2022] [Indexed: 11/16/2022] Open
Abstract
Objectives Study design Results Conclusion
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Affiliation(s)
- Kit Kitichotkul
- Department of Oral and Maxillofacial, Faculty of Dentistry, Chiang Mai University, Chiang Mai, Thailand
| | - Nirush Lertprasertsuke
- Department of Pathology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Sompid Kintarak
- Department of Stomatology, Faculty of Dentistry, Prince of Songkhla University, Songkhla, Thailand
| | - Surawut Pongsiriwet
- Department of Oral Biology and Diagnostic Sciences, Faculty of Dentistry, Chiang Mai University, Chiang Mai, Thailand
| | - Warit Powcharoen
- Department of Oral and Maxillofacial, Faculty of Dentistry, Chiang Mai University, Chiang Mai, Thailand
| | - Anak Iamaroon
- Department of Oral Biology and Diagnostic Sciences, Faculty of Dentistry, Chiang Mai University, Chiang Mai, Thailand
- Excellence Center in Osteology Research and Training Center (ORTC), Chiang Mai University, Chiang Mai, Thailand
- Corresponding author.
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Zhao X, Bao Y, Meng B, Xu Z, Li S, Wang X, Hou R, Ma W, Liu D, Zheng J, Shi M. From rough to precise: PD-L1 evaluation for predicting the efficacy of PD-1/PD-L1 blockades. Front Immunol 2022; 13:920021. [PMID: 35990664 PMCID: PMC9382880 DOI: 10.3389/fimmu.2022.920021] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 07/04/2022] [Indexed: 11/13/2022] Open
Abstract
Developing biomarkers for accurately predicting the efficacy of immune checkpoint inhibitor (ICI) therapies is conducive to avoiding unwanted side effects and economic burden. At the moment, the quantification of programmed cell death ligand 1 (PD-L1) in tumor tissues is clinically used as one of the combined diagnostic assays of response to anti-PD-1/PD-L1 therapy. However, the current assays for evaluating PD-L1 remain imperfect. Recent studies are promoting the methodologies of PD-L1 evaluation from rough to precise. Standardization of PD-L1 immunohistochemistry tests is being promoted by using optimized reagents, platforms, and cutoff values. Combining novel in vivo probes with PET or SPECT will probably be of benefit to map the spatio-temporal heterogeneity of PD-L1 expression. The dynamic change of PD-L1 in the circulatory system can also be realized by liquid biopsy. Consider PD-L1 expressed on non-tumor (immune and non-immune) cells, and optimized combination detection indexes are further improving the accuracy of PD-L1 in predicting the efficacy of ICIs. The combinations of artificial intelligence with novel technologies are conducive to the intelligence of PD-L1 as a predictive biomarker. In this review, we will provide an overview of the recent progress in this rapidly growing area and discuss the clinical and technical challenges.
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Affiliation(s)
- Xuan Zhao
- Jiangsu Center for the Collaboration and Innovation of Cancer Biotherapy, Cancer Institute, Xuzhou Medical University, Xuzhou, China
| | - Yulin Bao
- Jiangsu Center for the Collaboration and Innovation of Cancer Biotherapy, Cancer Institute, Xuzhou Medical University, Xuzhou, China
| | - Bi Meng
- Jiangsu Center for the Collaboration and Innovation of Cancer Biotherapy, Cancer Institute, Xuzhou Medical University, Xuzhou, China
| | - Zijian Xu
- Jiangsu Center for the Collaboration and Innovation of Cancer Biotherapy, Cancer Institute, Xuzhou Medical University, Xuzhou, China
| | - Sijin Li
- Jiangsu Center for the Collaboration and Innovation of Cancer Biotherapy, Cancer Institute, Xuzhou Medical University, Xuzhou, China
| | - Xu Wang
- Jiangsu Center for the Collaboration and Innovation of Cancer Biotherapy, Cancer Institute, Xuzhou Medical University, Xuzhou, China
| | - Rui Hou
- College of Pharmacy, Xuzhou Medical University, Xuzhou, China
| | - Wen Ma
- Jiangsu Center for the Collaboration and Innovation of Cancer Biotherapy, Cancer Institute, Xuzhou Medical University, Xuzhou, China
| | - Dan Liu
- Jiangsu Center for the Collaboration and Innovation of Cancer Biotherapy, Cancer Institute, Xuzhou Medical University, Xuzhou, China
- *Correspondence: Dan Liu, ; Junnian Zheng, ; Ming Shi,
| | - Junnian Zheng
- Jiangsu Center for the Collaboration and Innovation of Cancer Biotherapy, Cancer Institute, Xuzhou Medical University, Xuzhou, China
- *Correspondence: Dan Liu, ; Junnian Zheng, ; Ming Shi,
| | - Ming Shi
- Jiangsu Center for the Collaboration and Innovation of Cancer Biotherapy, Cancer Institute, Xuzhou Medical University, Xuzhou, China
- *Correspondence: Dan Liu, ; Junnian Zheng, ; Ming Shi,
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10
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Zheng YM, Yuan MG, Zhou RQ, Hou F, Zhan JF, Liu ND, Hao DP, Dong C. A computed tomography-based radiomics signature for predicting expression of programmed death ligand 1 in head and neck squamous cell carcinoma. Eur Radiol 2022; 32:5362-5370. [PMID: 35298679 DOI: 10.1007/s00330-022-08651-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 02/02/2022] [Accepted: 02/13/2022] [Indexed: 02/07/2023]
Abstract
OBJECTIVES Accurate prediction of the expression of programmed death ligand 1 (PD-L1) in head and neck squamous cell carcinoma (HNSCC) before immunotherapy is crucial. This study was performed to construct and validate a contrast-enhanced computed tomography (CECT)-based radiomics signature to predict the expression of PD-L1 in HNSCC. METHODS In total, 157 patients with confirmed HNSCC who underwent CECT scans and immunohistochemical examination of tumor PD-L1 expression were enrolled in this study. The patients were divided into a training set (n = 104; 62 PD-L1-positive and 42 PD-L1-negative) and an external validation set (n = 53; 34 PD-L1-positive and 19 PD-L1-negative). A radiomics signature was constructed from radiomics features extracted from the CECT images, and a radiomics score was calculated. Performance of the radiomics signature was assessed using receiver operating characteristics analysis. RESULTS Nine features were finally selected to construct the radiomics signature. The performance of the radiomics signature to distinguish between a PD-L1-positive and PD-L1-negative status in both the training and validation sets was good, with an area under the receiver operating characteristics curve of 0.852 and 0.802 for the training and validation sets, respectively. CONCLUSIONS A CECT-based radiomics signature was constructed to predict the expression of PD-L1 in HNSCC. This model showed favorable predictive efficacy and might be useful for identifying patients with HNSCC who can benefit from anti-PD-L1 immunotherapy. KEY POINTS • Accurate prediction of the expression of PD-L1 in HNSCC before immunotherapy is crucial. • A CECT-based radiomics signature showed favorable predictive efficacy in estimation of the PD-L1 expression status in patients with HNSCC.
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Affiliation(s)
- Ying-Mei Zheng
- Health Management Center, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Ming-Gang Yuan
- Department of Nuclear Medicine, Affiliated Qingdao Central Hospital, Qingdao University, Qingdao, China
| | - Rui-Qing Zhou
- Department of Radiology, Jiaozhou Hospital of Traditional Chinese Medicine, Jiaozhou, China
| | - Feng Hou
- Department of Pathology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Jin-Feng Zhan
- Department of Radiology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Nai-Dong Liu
- Department of Radiology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Da-Peng Hao
- Department of Radiology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Cheng Dong
- Department of Radiology, The Affiliated Hospital of Qingdao University, Qingdao, China.
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Atlas of PD-L1 for Pathologists: Indications, Scores, Diagnostic Platforms and Reporting Systems. J Pers Med 2022; 12:jpm12071073. [PMID: 35887569 PMCID: PMC9321150 DOI: 10.3390/jpm12071073] [Citation(s) in RCA: 36] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 06/27/2022] [Accepted: 06/29/2022] [Indexed: 12/24/2022] Open
Abstract
Background. Innovative drugs targeting the PD1/PD-L1 axis have opened promising scenarios in modern cancer therapy. Plenty of assays and scoring systems have been developed for the evaluation of PD-L1 immunohistochemical expression, so far considered the most reliable therapeutic predictive marker. Methods. By gathering the opinion of acknowledged experts in dedicated fields of pathology, we sought to update the currently available evidence on PD-L1 assessment in various types of tumors. Results. Robust data were progressively collected for several anatomic districts and leading international agencies to approve specific protocols: among these, TPS with 22C3, SP142 and SP263 clones in lung cancer; IC with SP142 antibody in breast, lung and urothelial tumors; and CPS with 22C3/SP263 assays in head and neck and urothelial carcinomas. On the other hand, for other malignancies, such as gastroenteric neoplasms, immunotherapy has been only recently introduced, often for particular histotypes, so specific guidelines are still lacking. Conclusions. PD-L1 immunohistochemical scoring is currently the basis for allowing many cancer patients to receive properly targeted therapies. While protocols supported by proven data are already available for many tumors, dedicated studies and clinical trials focusing on harmonization of the topic in other still only partially explored fields are surely yet advisable.
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12
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Concordance, Correlation, and Clinical Impact of Standardized PD-L1 and TIL Scoring in SCCHN. Cancers (Basel) 2022; 14:cancers14102431. [PMID: 35626035 PMCID: PMC9139955 DOI: 10.3390/cancers14102431] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 05/02/2022] [Accepted: 05/11/2022] [Indexed: 01/27/2023] Open
Abstract
Simple Summary In patients with relapsed or metastasized squamous cell cancer of the head and neck (R/M SCCHN), the PD-L1 Combined Positive Score (CPS) is currently the only predictive biomarker for treatment with anti-PD-1 agents. However, ambiguous results have been determined regarding the overall response rates of immunotherapeutic agents based on PD-L1 status, which may be partially attributed to spatiotemporal heterogeneity. Furthermore, tumor-infiltrating lymphocytes (TILs) have proven to be of significant prognostic value, yet lack of a standardized method for quantification impedes their integration into the current armamentarium of biomarkers in SCCHN. In this paper, concordance of PD-L1 CPS and stromal TILs was investigated in different paired samples of SCCHN subtypes. The results were then linked to well-known clinicopathological variables and prognosis. Abstract Background: The clinical significance of tumor-infiltrating lymphocytes (TILs) and programmed cell death-ligand 1 (PD-L1) expression has been thoroughly researched in squamous cell carcinoma of the head and neck (SCCHN). To address the impact of intra- and intertumoral heterogeneity in these biomarkers, we explored the concordance of PD-L1 combined positive score (CPS) and stromal TILs in different paired tissue sample types, while evaluating their internal relationship and prognostic impact. Methods: A total of 165 tissue blocks from 80 SCCHN patients were reviewed for TILs and PD-L1 CPS. Concordance between paired tissue samples was evaluated, and their association with several clinicopathological variables, overall survival (OS), and disease-free survival (DFS) was determined. Results: Biopsies and paired resection material were severely discordant in 39% and 34% of samples for CPS and TIL count, respectively, of which CPS was underscored in 27% of biopsies. In paired primary tumor–metastatic lesions, the disagreement was lower for CPS (19%) but not for TIL count (44%). PD-L1 CPS was correlated with prolonged OS when calculated from tissue acquirement, while extended OS and DFS were observed for high TIL density. Conclusion: Intertumoral and, especially, intratumoral heterogeneity were confounding factors when determining PD-L1 CPS and TIL count on paired tissue samples, indicating the increasing necessity of assessing both biomarkers on representative tissue material. Although TILs hold valuable prognostic information in SCCHN, the robustness of PD-L1 as a biomarker in SCCHN remains ambiguous.
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Ambrosini-Spaltro A, Limarzi F, Gaudio M, Calpona S, Meccariello G. PD-L1 expression in head and neck carcinoma by combined positive score: a comparison among preoperative biopsy, tumor resection, and lymph node metastasis. Virchows Arch 2022; 481:93-99. [PMID: 35420378 DOI: 10.1007/s00428-022-03322-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 02/13/2022] [Accepted: 04/05/2022] [Indexed: 12/22/2022]
Abstract
Immune checkpoint inhibitors have recently been approved for the treatment of advanced head and neck squamous cell carcinoma (HNSCC). The determination of PD-L1 using the combined positive score (CPS) is of utmost importance in the selection of patients. However, it is unclear which material should be examined. This study aimed to compare PD-L1 CPS in the resections of primary tumors and metastatic lymph nodes, and in the biopsies of the primary tumors.We collected 30 resected HNSCCs with lymph node metastases; in 17 of these, preoperative biopsies were retrieved. PD-L1 immunostaining of 75 samples was performed using the Dako 22C3 antibody on the Ventana ULTRA platform. An appropriate internal control was performed on each slide. CPS was calculated for each reaction. Concordance values and k were calculated for each patient. CPS cut-off values were fixed at 0 and 20.Tumors were resected from the oral cavity (4), oropharynx (17), hypopharynx (1), and larynx (8). The overall concordance of CPS between tumor resection and lymph node metastasis was 76.7% (k = 0.593). The overall concordance of CPS between tumor resection and tumor biopsy was 86.7% (k = 0.688). The agreement was moderate to substantial for each comparison.PD-L1 CPS may be correctly determined not only in resected primary tumors, but also in removed lymph node metastases, as well as in preoperative biopsies.
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Affiliation(s)
- Andrea Ambrosini-Spaltro
- Pathology Unit, Morgagni-Pierantoni Hospital, AUSL Romagna, Via Carlo Forlanini, 34, 47121, Forlì, Italy.
| | - Francesco Limarzi
- Pathology Unit, Morgagni-Pierantoni Hospital, AUSL Romagna, Via Carlo Forlanini, 34, 47121, Forlì, Italy
| | - Michele Gaudio
- Pathology Unit, Morgagni-Pierantoni Hospital, AUSL Romagna, Via Carlo Forlanini, 34, 47121, Forlì, Italy
| | - Sebastiano Calpona
- Clinical and Experimental Oncology of Immunotherapy and Rare Cancers, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
| | - Giuseppe Meccariello
- Otolaryngology and Head-Neck Surgery Unit, Morgagni-Pierantoni Hospital, AUSL Romagna, Forlì, Italy
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14
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Liu Z, Williams M, Stewart J, Glisson BS, Fuller C, Roy-Chowdhuri S. Evaluation of programmed death ligand 1 expression in cytology to determine eligibility for immune checkpoint inhibitor therapy in patients with head and neck squamous cell carcinoma. Cancer Cytopathol 2022; 130:110-119. [PMID: 34375025 PMCID: PMC8810615 DOI: 10.1002/cncy.22501] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 04/16/2021] [Accepted: 04/27/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Immune checkpoint inhibitors targeting the programmed cell death protein 1 (PD-1)/programmed cell death ligand 1 (PD-L1) pathway have recently emerged as a frontline treatment for head and neck squamous cell carcinoma (HNSCC). The evaluation of PD-L1 expression by immunohistochemistry in histologic samples is used to determine the eligibility of patients with HNSCC for immunotherapy. Patients with newly diagnosed HNSCC are frequently diagnosed by fine-needle aspiration (FNA) of lymph nodes with metastatic disease. However, the evaluation of PD-L1 expression with the proposed combined positive score (CPS) has not been well established in cytology specimens. METHODS This study retrospectively identified 21 HNSCC patients with a known PD-L1 status from histologic specimens and matched FNA specimens with tumor cells on cell blocks (CBs). The CB sections were stained with a PD-L1 antibody (22C3 clone). All cases were scored with CPS and the tumor proportion score (TPS). RESULTS The data showed substantial concordance between cytologic and histologic specimens for CPS (agreement, 76.2%; κ = 0.607) and TPS (agreement, 76.2%; κ = 0.607). With histology used as a reference standard, the positive predictive value was 100% for both CPS and TPS, whereas the negative predictive value was 57.1% for CPS assessments and 50% for TPS assessments. CONCLUSIONS PD-L1 expression in HNSCC cytology samples has high concordance with paired histologic samples. PD-L1 CPS evaluation is feasible in HNSCC cytology CBs and can act as a surrogate for determining eligibility for immunotherapy in cases in which a histologic specimen is not readily available.
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Affiliation(s)
- Zhonghua Liu
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Michelle Williams
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - John Stewart
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Bonnie S. Glisson
- Thoracic/Head and Neck Medical Oncology Department, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Clifton Fuller
- Radiation Oncology Department, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Sinchita Roy-Chowdhuri
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
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Zheng YM, Zhan JF, Yuan MG, Hou F, Jiang G, Wu ZJ, Dong C. A CT-based radiomics signature for preoperative discrimination between high and low expression of programmed death ligand 1 in head and neck squamous cell carcinoma. Eur J Radiol 2022; 146:110093. [PMID: 34890937 DOI: 10.1016/j.ejrad.2021.110093] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 11/19/2021] [Accepted: 11/30/2021] [Indexed: 02/07/2023]
Abstract
PURPOSE Accurate prediction of the expression level of programmed death ligand 1 (PD-L1) in head and neck squamous cell carcinoma (HNSCC) is crucial before immunotherapy. The purpose of this study was to construct and validate a contrast-enhanced computed tomography (CECT)-based radiomics signature to discriminate between high and low expression status of PD-L1. METHODS A total of 179 HNSCC patients who underwent immunohistochemical examination of tumor PD-L1 expression at one of two centers were enrolled in this study and divided into a training set (n = 122; 55 high PD-L1 expression and 67 low PD-L1 expression) and an external validation set (n = 57; 26 high PD-L1 expression and 31 low PD-L1 expression). The least absolute shrinkage and selection operator method was used to select the key features for a CECT-image-based radiomics signature. The performance of the radiomics signature was assessed using receiver operating characteristics analysis. RESULTS Six features were finally selected to construct the radiomics signature. The performance of the radiomics signature in the discrimination between high and low PD-L1 expression status was good in both the training and validation sets, with areas under the receiver operating characteristics curve of 0.889 and 0.834 for the training and validation sets, respectively. CONCLUSIONS The constructed CECT-based radiomics signature model showed favorable performance for discriminating between high and low PD-L1 expression status in HNSCC patients. It may be useful for screening out those patients with HNSCC who can best benefit from anti-PD-L1 immunotherapy.
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Affiliation(s)
- Ying-Mei Zheng
- Health Management Center, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Jin-Feng Zhan
- Department of Radiology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Ming-Gang Yuan
- Department of Nuclear Medicine, Affiliated Qingdao Central Hospital, Qingdao University, Qingdao, China
| | - Feng Hou
- Department of Pathology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Gang Jiang
- Department of Radiology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Zeng-Jie Wu
- Department of Radiology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Cheng Dong
- Department of Radiology, The Affiliated Hospital of Qingdao University, Qingdao, China.
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Paolino G, Pantanowitz L, Barresi V, Pagni F, Munari E, Moretta L, Brunelli M, Bariani E, Vigliar E, Pisapia P, Malapelle U, Troncone G, Girolami I, Eccher A. PD-L1 evaluation in head and neck squamous cell carcinoma: Insights regarding specimens, heterogeneity and therapy. Pathol Res Pract 2021; 226:153605. [PMID: 34530257 DOI: 10.1016/j.prp.2021.153605] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Revised: 08/28/2021] [Accepted: 08/28/2021] [Indexed: 12/19/2022]
Abstract
Immunohistochemical assessment with combined positive score (CPS) of programmed death-ligand 1 (PD-L1) is the prerequisite for administration of checkpoint inhibitor therapy in head and neck squamous cell carcinoma (HNSCC). Practicing pathologists are required to assess PD-L1 in routinary work and can be faced up with practical issues not always addressed in clinical trials or guidelines, such as choice of specimen to test, the intrinsic heterogeneity in PD-L1 expression in tumors and the potential impact of already administered therapy, given that patients' material can be procured at several times of cancer natural history. In the present work, we review and discuss the recent literature regarding the assessment of PD-L1 in HNSCC from the perspective of the practicing pathologist, providing some evidence on the single issues. It emerges a general trend to an underestimation of PD-L1 expression in biopsies compared to resection specimens and to a higher degree of positivity in metastatic lymph nodes in respect to primary tumors. Moreover, therapy shows to have contrasting effect on PD-L1 expression. Although further studies are needed, taking into account the intrinsic heterogeneity in PD-L1 expression and the conflicting evidences, it may be speculated that the most recent material of patients in respect to the natural history of tumor can be the most reliable to evaluate PD-L1 expression.
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Affiliation(s)
- Gaetano Paolino
- Pathology Unit, University and Hospital Trust of Verona, Aristide Stefani Square 1, 37126 Verona, Italy
| | - Liron Pantanowitz
- Department of Pathology & Clinical Labs, University of Michigan, 2800 Plymouth Rd building 35, Ann Arbor, MI 48109, USA
| | - Valeria Barresi
- Department of Diagnostics and Public Health, University of Verona, L.A. Scuro Square 1, 37134 Verona, Italy
| | - Fabio Pagni
- Department of Pathology, University of Milan-Bicocca, Ateneo Nuovo Square 1, 20126, Milan, Italy
| | - Enrico Munari
- Pathology Unit, Department of Molecular and Translational Medicine, University of Brescia, Spedali Civili Square 1, 25123 Brescia, Italy
| | - Lorenzo Moretta
- Immunology Area, Bambino Gesù Children's Hospital, IRCCS, San Paolo Street 15, 00146 Rome, Italy
| | - Matteo Brunelli
- Department of Diagnostics and Public Health, University of Verona, L.A. Scuro Square 1, 37134 Verona, Italy
| | - Elena Bariani
- Pathology Unit, University and Hospital Trust of Verona, Aristide Stefani Square 1, 37126 Verona, Italy
| | - Elena Vigliar
- Department of Public Health, University of Naples Federico II, Pansini Street 5, 80131 Naples, Italy
| | - Pasquale Pisapia
- Department of Public Health, University of Naples Federico II, Pansini Street 5, 80131 Naples, Italy
| | - Umberto Malapelle
- Department of Public Health, University of Naples Federico II, Pansini Street 5, 80131 Naples, Italy
| | - Giancarlo Troncone
- Department of Public Health, University of Naples Federico II, Pansini Street 5, 80131 Naples, Italy
| | - Ilaria Girolami
- Division of Pathology, Central Hospital Bolzano, Lorenz Böhler Street 5, 39100, Bolzano, Italy
| | - Albino Eccher
- Pathology Unit, University and Hospital Trust of Verona, Aristide Stefani Square 1, 37126 Verona, Italy.
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De Keukeleire SJ, Vermassen T, Hilgert E, Creytens D, Ferdinande L, Rottey S. Immuno-Oncological Biomarkers for Squamous Cell Cancer of the Head and Neck: Current State of the Art and Future Perspectives. Cancers (Basel) 2021; 13:1714. [PMID: 33916646 PMCID: PMC8038541 DOI: 10.3390/cancers13071714] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 03/19/2021] [Accepted: 03/26/2021] [Indexed: 12/24/2022] Open
Abstract
The era of immune checkpoint inhibitors has altered the therapeutic landscape in squamous cell cancer of the head and neck (SCCHN). Our knowledge about the tumor microenvironment has fueled the research in SCCHN, leading to several well-known and less-known prognostic and predictive biomarkers. The clinical staging, p16/HPV status, and PD-L1 expression are currently the main tools for assessing the patients' diagnosis and prognosis. However, several novel biomarkers have been thoroughly investigated, some reaching actual significant clinical contributions. The untangling of the immune infiltrate with the subtyping of tissue-associated tumor infiltrating lymphocytes, tumor-associated macrophages, and circulating blood-based biomarkers are an interesting avenue to be further explored and prospectively assessed. Although PD-L1 expression remains the most important response predictor for immune checkpoint inhibitors, several flaws impede proper assessment such as technical issues, different scoring protocol, and intra-, inter-, and temporal heterogeneity. In addition, the construction of an immune-related gene panel has been proposed as a prognostic and predictive stratification but lacks consensus. Recently, the role of microbioma have also been explored regarding its systemic and antitumor immunity. This review gives a comprehensive overview of the aforementioned topics in SCCHN. To this end, the integration of these clinically advantageous biomarkers via construction of an immunogram or nomogram could be an invaluable tool for SCCHN in future prospects.
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Affiliation(s)
- Stijn J. De Keukeleire
- Department of Medical Oncology, University Hospital Ghent, 9000 Ghent, Belgium; (T.V.); (S.R.)
- Cancer Research Institute Ghent (CRIG), 9000 Ghent, Belgium; (E.H.); (D.C.); (L.F.)
- Drug Research Unit Ghent, University Hospital Ghent, 9000 Ghent, Belgium
| | - Tijl Vermassen
- Department of Medical Oncology, University Hospital Ghent, 9000 Ghent, Belgium; (T.V.); (S.R.)
- Cancer Research Institute Ghent (CRIG), 9000 Ghent, Belgium; (E.H.); (D.C.); (L.F.)
- Drug Research Unit Ghent, University Hospital Ghent, 9000 Ghent, Belgium
| | - Elien Hilgert
- Cancer Research Institute Ghent (CRIG), 9000 Ghent, Belgium; (E.H.); (D.C.); (L.F.)
- Centre for Medical Genetics Ghent (CMGG), University Hospital Ghent, 9000 Ghent, Belgium
| | - David Creytens
- Cancer Research Institute Ghent (CRIG), 9000 Ghent, Belgium; (E.H.); (D.C.); (L.F.)
- Department of Pathology, University Hospital Ghent, 9000 Ghent, Belgium
| | - Liesbeth Ferdinande
- Cancer Research Institute Ghent (CRIG), 9000 Ghent, Belgium; (E.H.); (D.C.); (L.F.)
- Department of Pathology, University Hospital Ghent, 9000 Ghent, Belgium
| | - Sylvie Rottey
- Department of Medical Oncology, University Hospital Ghent, 9000 Ghent, Belgium; (T.V.); (S.R.)
- Cancer Research Institute Ghent (CRIG), 9000 Ghent, Belgium; (E.H.); (D.C.); (L.F.)
- Drug Research Unit Ghent, University Hospital Ghent, 9000 Ghent, Belgium
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Hirshoren N, Al-Kharouf I, Weinberger JM, Eliashar R, Popovtzer A, Knaanie A, Fellig Y, Neuman T, Meir K, Maly A, Vainer GW. Spatial Intratumoral Heterogeneity Expression of PD-L1 Antigen in Head and Neck Squamous Cell Carcinoma. Oncology 2021; 99:464-470. [PMID: 33789303 DOI: 10.1159/000515441] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 02/23/2021] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Immune-checkpoint inhibitors have demonstrated a significant survival benefit in metastatic and non-resectable head and neck squamous cell carcinoma (HNSCC). Patients with a combined positivity score (CPS) of 20 and higher benefit the most from therapy. Inaccurate definition of the CPS category might lead to the incorrect stratification of patients to immunotherapy. This study's main aim was to investigate programmed death-ligand 1 (PD-L1) antigen expression in HNSCC in diverse clinical situations and histological settings. MATERIALS AND METHODS This is a prospective cohort study conducted in a tertiary referral medical center. Tissues were investigated for PD-L1 expression using the FDA-approved 22C3 immunohistochemistry assay (Dako). We analyzed potential associations between the CPS category and meaningful demographic, clinical, and outcome metrics. Furthermore, we investigated morphologically separate sites for CPS scores in whole surgical tissue specimens and matched preoperative biopsies. RESULTS We analyzed 36 patients, of whom 26 had oral cavity SCC and 10 had laryngeal SCC. The overall, disease-specific, and progression-free survival of the HNSCC group of patients were not associated with the CPS category (p = 0.45, p = 0.31, and p = 0.88, respectively). There was a significant (18%, 95% CI 0.65-0.9) inconsistency between the CPS category determined in biopsies versus whole carcinoma analyses. We also found an uneven distribution of whole-tumor CPS attributed to spatial carcinoma invasiveness, tumor differentiation, and inflammatory cell infiltration heterogeneity. DISCUSSION AND CONCLUSIONS Our data suggest that careful selection of tumor area for CPS analysis is important. PD-L1 antigen expression, clinically represented by CPS, may be up- or down-categorized in different clinical and pathological circumstances. The high whole-tissue CPS category scatter may clinically result in potential treatment modifications. We argue that CPS analysis requires not only adequacy (at least 100 viable tumor cells), but also correct representation of the tumor microenvironment.
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Affiliation(s)
- Nir Hirshoren
- Department of Otolaryngology/Head and Neck Surgery, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Issa Al-Kharouf
- Department of Pathology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Jeffrey M Weinberger
- Department of Otolaryngology/Head and Neck Surgery, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Ron Eliashar
- Department of Otolaryngology/Head and Neck Surgery, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Aron Popovtzer
- Sharett Institute of Oncology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Ariela Knaanie
- Department of Otolaryngology/Head and Neck Surgery, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Yakov Fellig
- Department of Pathology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Tzahi Neuman
- Department of Pathology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Karen Meir
- Department of Pathology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Alexander Maly
- Department of Pathology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Gilad W Vainer
- Department of Pathology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
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High Expression of Programmed Death Ligand 1 and Programmed Death Ligand 2 in Ophthalmic Sebaceous Carcinoma: The Case for a Clinical Trial of Checkpoint Inhibitors. Am J Ophthalmol 2020; 220:128-139. [PMID: 32730911 DOI: 10.1016/j.ajo.2020.07.031] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 07/17/2020] [Accepted: 07/20/2020] [Indexed: 12/18/2022]
Abstract
PURPOSE To evaluate the expression of programmed death ligand 1 (PD-L1) and programmed death ligand 2 (PD-L2) in ocular adnexal sebaceous carcinoma (OASC), and to appraise these findings within the context of recent comparable studies. DESIGNS Retrospective case series. METHODS Twenty cases of primary OASC were immunostained for PD-L1, PD-L2 and CD8. PD-L1 and PD-L2 expression were graded with both the combined positive score (CPS) and the tumor proportion score (TPS). Both raw CPS and TPS were reported, as well as positivity with TPS and CPS ≥1. CD8 expression was graded on a 0-3 scale. Charts were reviewed for clinical correlations. The results of the current study were compared with results of similar recent investigations. RESULTS For the 20 cases, mean expression of PD-L1 with CPS was 29.7 (range 0-101.5) and with TPS was 12.2 (range 0-95.8); mean expression of PD-L2 with CPS was 7.9 (range 0-37.3) and with TPS was 1.9 (range 0-12.9). PD-L1 CPS ≥1 was detected in 95% of OASC, while PD-L1 TPS ≥1 was found in 75%. PD-L2 CPS ≥1 was present in 60%, while only 20% had PD-L2 TPS ≥1. Immune cells appeared to contribute to a substantial proportion of PD-L1 and PD-L2 positivity, and a conspicuous CD8-positive T-lymphocytic infiltrate was present in most tumors. Significant correlations were identified between tissue expression of PD-L1, PD-L2, and CD8. Tissues with greater levels of PD-L1 tended to express higher levels of PD-L2 and CD8. The degree of PD-L1 and PD-L2 expression was also associated with the area in millimeters squared of the immunostained tumor, suggesting that tumor sampling may influence interpretation of PD-L1 and PD-L2 expression in ocular adnexal tumors. CONCLUSIONS The current and preceding studies confirm that PD-L1 and PD-L2 are expressed in a high percentage of OASCs. These results support the premise that checkpoint inhibitor drugs hold considerable therapeutic promise for patients with OASC and stimulate the institution of clinical trials.
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