Predicting Which Lung Cancer Patients Will Benefit From Immunotherapy

The Value of the TPS Score

• The Tumor Proportion Score (TPS) determines PD-L1 protein expression in a tumor
• This score can help predict which patients are likely to benefit from single-drug immunotherapy
• Patients with a TPS score of less than 50% typically receive chemoimmunotherapy

Immune checkpoint inhibitors like pembrolizumab have been a major advancement in the treatment of non-small cell lung cancer (NSCLC), but they need to be prescribed strategically to have the greatest benefit. That requires looking at the immune landscape of the cancer using PD-L1 immunohistochemistry, and specifically the Tumor Proportion Score (TPS).

“Based on that score, we can identify patients with a high likelihood of benefit from a single agent immunotherapy,” Dr. Balazs Halmos, medical oncologist and director of the Thoracic Oncology Program at Montefiore Medical Center, tells SurvivorNet Connect.

In patients with a TPS score of less than 50%, the current standard of care is a combination of chemotherapy and immunotherapy.

Although therapeutic options are on the rise, there is a need for additional biomarkers to guide drug selection. “We need to invest into understanding the molecular and immune landscape of a lung cancer,” Dr. Halmos says. Next-generation sequencing using circulating tumor DNA (ctDNA) has increased the efficiency and speed of decoding the tumor’s molecular and immune landscape, he adds, “so our patients can start on their treatment path earlier on for their benefit.”