Dr. Pinato Discusses Intra-tumor Heterogeneity in Primary and Metastatic HCC

David J. Pinato, MD, PhD, NIHR Academic Clinical Lecturer in Medical Oncology, resident, Royal Brompton Hospital and Imperial College London, discusses an analysis of intra-tumor heterogeneity in primary and metastatic hepatocellular carcinoma (HCC).

PD-1/PD-L1 therapies have recently shown efficacy in patients with HCC, says Pinato, adding that approximately 20% of patients will respond to these treatments. However, patient selection is a challenge. PD-L1 expression has been advocated as a stratifying biomarker but, in early-phase trials, PD-L1 has not been predictive of response.

In an analysis, researchers sought to determine, in patients with disseminated disease, whether PD-L1, PD-L2, and other immune-tolerogenic pathways are distributed across primary and metastatic disease. Clinical samples were profiled with immunohistochemistry and Nanostring technologies. Findings showed that PD-L2 was in-adversely distributed across primary and metastatic disease, but PD-L1 was not. Therefore, there was high discordance and this could have been caused by sampling bias, Pinato explains.