OBJECTIVES

: Immunotherapy has introduced a new era in lung cancer treatment, including checkpoint inhibitors that target the Programmed Cell Death/Programmed Death Ligand 1 (PD-1/PD-L1) pathways. In this retro-prospective observational study, we analyzed PD-L1 testing patterns for metastatic non-small cell lung cancer (NSCLC) in a large health maintenance organization in Israel since the approval of immunotherapy in first-line in the basket of health services.

METHODS

: Patients with newly diagnosed metastatic NSCLC who initiated systemic anti-cancer treatment from 1st January 2017 were identified from the Israel national cancer registry. Their demographic, clinical and treatment data were collected from the Maccabi Healthcare System patient database and extracted from medical documents. Descriptive statistics on patient characteristics, PD-L1 testing rates and tumor proportion score (TPS) were generated.

RESULTS

: This interim study of 112 patients consisted of 60% males and 55% aged over 65 years. Among 64% of patients there was an indication of current or former smoking. A total of 80% had adenocarcinoma, 14% squamous cell carcinoma, and 13% had brain metastases. ECOG performance status at diagnosis was available for 79% of patients, of whom 81% had a score of 0-1.

Information for PD-L1 or driver mutation testing was available for 95% of patients. PD-L1 testing was carried out using the 22C3 antibody on the Ventana platform in 76% of patients, with 40% having a TPS result of 50% or more. Driver mutation testing was carried out in 88% of patients, of whom 22% were positive for EGFR and 2% for ALK. Other patients may have been tested in the private sector.

CONCLUSIONS

: This interim analysis indicates that PD-L1 testing rates had a fast uptake of this new technology in Israel.