What Would Your Oncologist Think If…
A perspective on current issues in PD-L1 testing
Roberto Salgado | | Opinion
What would your oncologist colleague think if you, a pathologist, said that you would order one of three different assays for her hormone receptor-positive breast cancer patient depending on whether she planned to treat with an aromatase inhibitor (for example, exemestane), tamoxifen, or fulvestrant? Would she perhaps wonder why each treatment required a different test? After all, are you not asking the same questions about the patient’s health regardless of the treatment the oncologist selects?
What would the oncologist think if you then tell her that, for each different assay, you are going to use a different method of scoring? Some scoring systems combine tumor cells with immune cells, whereas others score only tumor cells, and still others only immune cells. You might even add that each assay has a different cutoff for positive or negative results – so a patient assessed with scoring system X is considered positive, but the same patient under scoring system Y is considered negative. And then, on top of that, each assay has a different sensitivity (some three times more sensitive than others) – even though the antibodies used are very similar. In short, depending solely on the assay you use, the patient’s results – and therefore treatment – may change.
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