Standardized and quality-assured predictive PD-L1 testing in the upper gastrointestinal tract

Abstract

As a result of the high approval dynamics and the growing number of immuno-oncological concepts, the complexity of treatment decisions and control in the area of cancers of the esophagus, gastroesophageal junction and stomach is constantly increasing. Since the treatment indication for PD-1 inhibitors that are currently approved in the European Union is often linked to the expression of PD-L1 (programmed cell death-ligand 1), the evaluation of tissue-based predictive markers by the pathologist is of crucial importance for treatment stratification. Even though the immunohistochemical analysis of the PD-L1 expression status is one of the best studied, therapy-relevant biomarkers for an immuno-oncological treatment, due to the high heterogeneity of carcinomas of the upper gastrointestinal tract, there are challenges in daily clinical diagnostic work with regard to implementation, standardization and interpretation of testing. An interdisciplinary group of experts from Germany has taken a position on relevant questions from daily pathological and clinical practice, which concern the starting material, quality-assured testing and the interpretation of pathological findings, and has developed recommendations for structured reporting.

Keywords: Esophageal squamous cell carcinoma; Gastric adenocarcinoma; Gastroesophageal junction adenocarcinoma; Immune checkpoint inhibitor; PD-L1 testing; Predictive biomarkers.

Fig. 1

Overview of PD-L1-dependent approvals in first-line locally advanced unresectable or metastatic upper gastrointestinal carcinoma (status of information: April 2023)