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IMMUNOTHERAPY

BFAST but be smart: bTMB remains an exploratory biomarker in NSCLC

A high tumour mutational burden (≥10 mutations per megabase) is a companion biomarker in the histology-agnostic approval of pembrolizumab for treatment-refractory advanced-stage solid tumours, and continues to be an exploratory predictive biomarker for immune-checkpoint inhibitors in non-small-cell lung cancer. Herein, we discuss recent results from the first phase III trial evaluating blood-based tumour mutational burden in patients with treatment-naive advanced-stage non-small-cell lung cancer.

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References

  1. Hellmann, M. D. et al. Nivolumab plus ipilimumab in advanced non-small-cell lung cancer. N. Engl. J. Med. 381, 2020–2031 (2019).

    Article  CAS  Google Scholar 

  2. Carbone, D. P. et al. First-line nivolumab in stage IV or recurrent non-small-cell lung cancer. N. Engl. J. Med. 376, 2415–2426 (2017).

    Article  CAS  Google Scholar 

  3. Kim, E. S. et al. Blood-based tumor mutational burden as a biomarker for atezolizumab in non-small cell lung cancer: the phase 2 B-F1RST trial. Nat. Med. 28, 939–945 (2022).

    Article  CAS  Google Scholar 

  4. Herbst, R. S. et al. Atezolizumab for first-Line treatment of PD-L1-selected patients with NSCLC. N. Engl. J. Med. 383, 1328–1339 (2020).

    Article  CAS  Google Scholar 

  5. Peters, S. et al. Atezolizumab versus chemotherapy in advanced or metastatic NSCLC with high blood-based tumor mutational burden: primary analysis of BFAST cohort C randomized phase 3 trial. Nat. Med. 28, 1831–1839 (2022).

    Article  CAS  Google Scholar 

  6. Sturgill, E. G. et al. Discordance in tumor mutation burden from blood and tissue affects association with response to immune checkpoint inhibition in real-world settings. Oncologist 27, 175–182 (2022).

    Article  Google Scholar 

  7. Gandara, D. R. et al. Blood-based tumor mutational burden as a predictor of clinical benefit in non-small-cell lung cancer patients treated with atezolizumab. Nat. Med. 24, 1441–1448 (2018).

    Article  CAS  Google Scholar 

  8. Rizvi, N. A. et al. Durvalumab with or without tremelimumab vs standard chemotherapy in first-line treatment of metastatic non-small cell lung cancer: the MYSTIC phase 3 randomized clinical trial. JAMA Oncol. 6, 661–674 (2020).

    Article  Google Scholar 

  9. Vesely, M. D., Zhang, T. & Chen, L. Resistance mechanisms to anti-PD cancer immunotherapy. Annu. Rev. Immunol. 40, 45–74 (2022).

    Article  Google Scholar 

  10. Jiang, T. et al. On-treatment blood TMB as predictors for camrelizumab plus chemotherapy in advanced lung squamous cell carcinoma: biomarker analysis of a phase III trial. Mol. Cancer 21, 4 (2022).

    Article  CAS  Google Scholar 

Download references

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Correspondence to Roy S. Herbst.

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Competing interests

R.S.H. is on the board of directors for Immunocore and Junshi Pharmaceuticals; holds stock options in Bolt Biotherapeutics, Checkpoint Therapeutics, and Immunocore; has received fees for consultancy roles from AstraZeneca, Bolt Biotherapeutics, Bristol Myers Squibb, Candel Therapeutics, Checkpoint Therapeutics, Cybrexa Therapeutics, DynamiCure Biotechnology, eFFECTOR Therapeutics, Eli Lilly, EMD Serono, Genentech, Gilead, HiberCell, I-Mab Biopharma, Immune-Onc Therapeutics, Immunocore, Janssen, Johnson and Johnson, Junshi Pharmaceuticals, Loxo Oncology, Merck, Mirati Therapeutics, NextCure, Novartis, Ocean Biomedical, Oncocyte, Oncternal Therapeutics, Pfizer, Regeneron Pharmaceuticals, Revelar Biotherapeutics, Ribbon Therapeutics, Roche, Sanofi, and Xencor; and has received research support from AstraZeneca, Eli Lilly, Genentech/Roche, and Merck. He also holds leadership roles for the American Association for Cancer Research, International Association for the Study of Lung Cancer, Society for Immunotherapy of Cancer, and Southwest Oncology Group. S.Y.K. declares no competing interests.

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ClinicalTrials.gov: https://clinicaltrials.gov/

TMB Harmonization Project: https://friendsofcancerresearch.org/tmb/

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Kim, S.Y., Herbst, R.S. BFAST but be smart: bTMB remains an exploratory biomarker in NSCLC. Nat Rev Clin Oncol 20, 3–4 (2023). https://doi.org/10.1038/s41571-022-00698-y

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