Fast Five Quiz: Genetics of Non–Small Cell Lung Cancer

Daniel S. Schwartz, MD, MBA


February 03, 2021

Patients with a TMB ≥ 20 mut/Mb have an increased likelihood of responding to immunotherapy than patients with a TMB < 10 mut/Mb, according to an exploratory analysis from the recent phase 3 MYSTIC trial. The National Comprehensive Cancer Network (NCCN) Clinical Practice Guidelines in Non–Small Cell Lung Cancer currently recommend clinicians obtain patient TMB levels to determine suitability for treatment with first-line nivolumab as a monotherapy or in combination with ipilimumab; however, no consensus has been reached regarding the best method to measure TMB.

As with TMB, both high PD-L1 levels and high TIL levels have been associated with better responses to checkpoint inhibitor therapy. However, the NCCN currently recommends checkpoint inhibitor therapy for some patients based on PD-L1 positivity but does not offer recommendations based on TIL status.

Due to the complexity of relevant data, some experts believe that computerized algorithms may be required to accurately utilize multiple markers at once.

Learn more about non–small cell lung cancer staging.


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