Dr. Herbst on TMB as a Biomarker in NSCLC

Roy S. Herbst, MD, PhD, professor of medicine, chief of medical oncology, Yale Cancer Center and Smilow Cancer Hospital, discusses tumor mutational burden (TMB) as a biomarker in non—small cell lung cancer (NSCLC).

TMB is a very interesting biomarker, says Herbst, and it’s been tested frequently with patients with NSCLC, with many assays being cross-validated. Data coming from the IMpower and CheckMate trials are very compelling. There’s no doubt that TMB correlates with outcomes for patients receiving immunotherapy. However, research is left to be done to see if this differentiates immunotherapy from chemotherapy or immunotherapy from a combination regimen. There are some hints that physicians can use TMB to administer the immunotherapy combination of ipilimumab (Yervoy) and nivolumab (Opdivo), Herbst says.

Herbst adds that testing for TMB and PD-L1 expression could soon be used in a dichotomous way. For example, if a patient is PD-L1 negative and has no detectable TMB, this is a good case to determine a way to rev up the immune system.