Immune Markers in Non-Small Cell Lung Cancer: What Else Beyond Pd-L1 and Tumour Mutational Burden is there?

Abstract

The advancement of immune-oncology and immunotherapy in recent decades is unprecedented. Immune evasion and cancer promoting inflammation have been added as new hallmarks of malignancy. This opened a view of cancer as an immunological disease. Non-small cell lung cancer [NSCLC] is one of the leading cancer types in terms of immunotherapy research and implication. The need for predictive markers to immune checkpoint inhibitors fuels the search for immune markers in NSCLC. However, since the importance of immune evasion is now recognised, defining the immunological phenotype of NSCLC can have broader implications. Immune markers may aid in better defining the prognosis, supplement TNM staging and predict response to all modalities of treatment. PD-L1 and TMB are immune markers firmly established in clinical practice. However, 2 markers can hardly capture the full scope of immune response in cancer. We have searched PubMed, Cochrane and clinicaltrials.gov databases to compile a brief review of immune markers that seem closest to daily clinical practice in NSCLC other than PD-L1 and TMB. Our aim is to review the possible implications of these markers in personalization of treatment of NSCLC patients. The immune markers helpful in defining prognosis, staging and predicting response to various treatment modalities.