Goodbye PD-L1?

[WEBB PINKERTON]

Is PD-L1 testing going to be a thing of the past with new FDA approval for Keytruda that just came out?

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[pathslides]

Is PD-L1 testing going to be a thing of the past with new FDA approval for Keytruda that just came out?

Oncologists will just ask for MSI testing on everything now.

 

[coroner]

PD-L1 testing is here to stay regardless of FDA approval of Keytruda for multiple reasons:

1) It’s still part of the NCCN guidelines for squamous cell carcinoma of the lung

2) It’s almost always the first test ordered for NSCLC w/ or w/o EGFR vs ALK, and ROS.

3) Different assays for PD-L1 can affect the type of immunotherapy given e.g. Keytruda vs Tecentriq.

4) Clinicians are still going to want all info available at their disposal

Not to mention, it’s a valid test we can interpret and bill for, sort of like when everybody started doing HER-2. So pathologists will be more than happy to continue to do so with PD-L1.

 

[coroner]

You may have a point though. Although I still think PD-L1 will still be used, with the FDA approval of Keytruda, the reimbursement rates of this expensive treatment no longer hinges on PD-L1 testing because it is now a complementary test instead of a companion test. So, testing it could either stabilize or possibly decrease, but such changes probably won't become evident for another few years. Not sure what the future holds...

 

[WEBB PINKERTON]

If we weren't playing with monopoly money, it would decrease. We all see overkill on a daily basis in medicine so look for testing to stabilize or increase. The vendors and labs have to keep the machine fed so there can't be a reduction in demand.