Discordância da expressão de PD-L1 entre o câncer de pulmão metastático não-pequeno metastático primário e pareado: revisão sistemática e metanálise

Resumo original em inglês

O que aconteceu

PD-L1 expression in non-small cell lung cancer (NSCLC) serves as a key predictive biomarker of response to immune checkpoint inhibitors; however, the concordance of PD-L1 expression between primary tumors and their corresponding metastatic lesions remains uncertain. We therefore performed a systematic review and meta-analysis to evaluate the variability of PD-L1 expression across paired primary and metastatic NSCLC sites.

We systematically searched the Cochrane Library, Embase, PubMed, and Web of Science for eligible studies. Pooled discordance rates and patterns of mismatch were estimated using a random-effects model, and subgroup analyses were conducted according to PD-L1 cutoff, antibody clone, and metastatic site.

In patients with NSCLC, PD-L1 expression frequently differs between primary and metastatic lesions, with a greater tendency for expression to decrease at metastatic sites. These findings indicate that PD-L1 results obtained from an archival primary tumor should be interpreted with caution when they are used to inform treatment of metastatic disease. Whether repeat testing of metastatic tissue improves patient selection or immunotherapy outcomes has not been demonstrated and requires prospective evaluation.

https://www.crd.york.ac.uk/PROSPERO, identifier CRD42022336191.

O que encontraram

Fifteen studies fulfilled the inclusion criteria, encompassing 1,029 matched primary-metastatic sample pairs from 1,014 patients with NSCLC. The pooled analysis revealed an overall PD-L1 discordance rate of 21% between primary tumors and corresponding metastases (95% CI: 18%-25%). Notably, transitions from PD-L1-positive primary tumors to PD-L1-negative metastatic lesions occurred more frequently (26%, 95% CI: 22%-30%) than the reverse pattern, from negative primaries to positive metastases (18%, 95% CI: 12%-24%). Discordance of similar magnitude was observed across PD-L1 positivity thresholds and antibody clones and in both lymph node and brain metastases, although the site-specific estimates are exploratory.

Resumo publicado sob licença CC BY. A tradução para o português ainda não chegou a este estudo.