Neoadjuvant checkpoint blockade for cancer immunotherapy

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Science  31 Jan 2020:
Vol. 367, Issue 6477, eaax0182
DOI: 10.1126/science.aax0182

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  • Should we regard the tumor cells with a lepidic growth pattern as RVT in the specimen of lung adenocarcinoma responding to neoadjuvant immunotherapy?
    • jianming Ying, Pathologist, Department of Pathology, National Cancer Center/ /Cancer Hospital, Chinese Academy of Medical Sciences

    In the Figure 2A of the Review, the histologic morphology of the circled residual viable tumor (RVT) area shows a tendency to reactive pneumocyte hyperplasia or tumor cells with a pure lepidic growth pattern, instead of invasive adenocarcinoma. %RVT is the most commonly used metrics for assessing pathologic response to neoadjuvant immunotherapy in the era of PD-1 pathway blockade, as an early parameter portending clinical outcomes. However, identification of RVT in the tumor bed of the specimens from some patients with lung adenocarcinoma responding to neoadjuvant immunotherapy is challenging. In these cases, it is difficult to distinguish RVT cells with pure lepidic growth pattern from reactive pneumocyte hyperplasia secondary to parenchymal inflammation, while the latter is common in lung cancer. This differentiation is quite important to calculate %RVT, especially in defining a patient to complete pathologic response (pCR) or major pathologic response (MPR, usually no more than 10%RVT). As tumor cells with pure lepidic growth pattern is referred as adenocarcinoma in situ, when only these tumor cells are present in the tumor bed, it should not be calculated as RVT in the assessment of immune-related pathologic response to neoadjuvant immunotherapy.

    Competing Interests: None declared.

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