Serum test identifies patients deriving benefit from CPIs 191 5 Additional validation of the test in other larger cohorts of patients treated with CPIs is necessary. So far, we have investigated the ability of the test to stratify outcome for patients receiving checkpoint blockade monotherapy in the second- and higherline setting, after platinum-based chemotherapy. However, now immunotherapy is moving into the first-line setting, either as monotherapy for patients with PD-L1 expression greater than 50%, or in combination with chemotherapy. It is of interest to evaluate the performance of the test in these first-line settings. A prospective trial, comparing outcomes between mono- immunotherapy and the chemoimmunotherapy combination in front-line patients with high PD-L1 expression is in the final stages of design. Studies in earlier stage patients receiving durvalumab with chemoradiation would also be informative. Evaluation of the test with appropriate comparator non-immunotherapy regimens in a prospective, randomized setting would be required to unequivocally determine its predictive power and clinical utility.
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