Research Papers:

PD-L1 expression indicates favorable prognosis for advanced lung adenocarcinoma patients treated with pemetrexed

Pei Zhang, Zhang Bao, Liming Xu, Jianya Zhou, Guohua Lu, Yinan Yao, Rong Liu, Qiqi Gao, Yihong Shen and Jianying Zhou _

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Oncotarget. 2017; 8:66293-66304. https://doi.org/10.18632/oncotarget.19973

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Pei Zhang1,*, Zhang Bao1,*, Liming Xu2, Jianya Zhou1, Guohua Lu1, Yinan Yao1, Rong Liu1, Qiqi Gao2, Yihong Shen1 and Jianying Zhou1

1Department of Respiratory Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China

2Department of Pathology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China

*These authors have contributed equally to this work

Correspondence to:

Jianying Zhou, email: [email protected]

Keywords: programmed death ligand 1, pemetrexed, immunohistochemistry, lung adenocarcinoma

Received: December 06, 2016    Accepted: July 24, 2017    Published: August 07, 2017


Conventional chemotherapy for lung cancer exerts anti-tumor effects through cytotoxicity, and through immunologic regulation by reducing specific T cell subsets and inducing the expression of programmed death ligand 1 (PD-L1) on tumor cells. Even though pemetrexed has shown huge potential in combination with other targeted or immune therapies, there is still little information about the values of specific immune checkpoint markers for advanced lung adenocarcinoma treated with pemetrexed. In the present study, a total of 56 patients with advanced lung adenocarcinoma, who received pemetrexed-based chemotherapy, were included retrospectively. Immunohistochemistry was performed to assess PD-L1, programmed death 1 (PD-1), thymidylate synthase, and tumor infiltrating lymphocytes (TILs). In this cohort, the positive expression of PD-L1 and PD-1 were 26.8% and 33.9% respectively. PD-L1, PD-1, and thymidylate synthase expression were not significantly associated with any clinical features, while the expression of both PD-L1 and PD-1 were correlated with Ki-67 expression. Furthermore, the expression of PD-1 was significantly correlated with TILs. The progression-free survival (PFS) in patients with PD-L1+ specimens was significantly longer compared to PD-L1 specimens. Moreover, PD-L1 expression was an independent protective factor for PFS, and the smoking status was an independent risk factor. PD-L1 expression was significantly associated with better prognosis for patients with pemetrexed-based treatment. Our findings suggested that PD-L1 expression might be a favorable prognostic biomarker for pemetrexed-based regimen, which is a rationale for combining immunotherapy with chemotherapy for lung cancer.

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