Biomarkers in non-small cell lung cancer patients: are they always worth looking for?

Background: Oncogene mutations and immune response biomarkers are main indicators of NSCLC prognosis. Biomarkers detection is endorsed in advanced stages of disease. Recent evidence suggests that target therapies might be crucial even in resectable NSCLC. Aim: To assess biomarkers expression and identify related clinical variables in a group of well characterized patients (pts) diagnosed with NSCLC. Methods: Clinico-pathological data of NSCLC pts (Jan-May 2022) were assessed. Only those with complete assessment of PD-L1 expression and 7 biomarkers - ALK, ROS1, MET, RET, BRAF, EGFR, KRAS - were included. Links between tissue targets and clinical phenotype were investigated. Results: Among the 119 pts included, PD-L1 expression was not related to smoking history, gender, age, histotype (PD-L1>50% detected in 31% adenocarcinoma and 43% squamous cell carcinomas). The presence of molecular aberrations, identified in 58/119 (49%), was similar in the 3 groups of differentially expressed PD-L1. Women (50% vs 33%; p=0.01) with adenocarcinoma (100%) who smoked less (24±17 vs 48±35 p.y.; p=0.03) had higher probability of sharing at least 1 targetable oncogene. Stage I pts had a significant proportion of molecular aberrations (50%) and of PD-L1 expression >50% (27%) not different than stage IV (respectively, 56% and 42%). Conclusions: Biomarkers, when tissue samples are adequate, are commonly found in NSCLC. PD-L1 expression was not associated with a clinical phenotype and did not condition the probability of finding molecular aberrations. Oncogenic mutations are more common among adenocarcinoma women, regardless of stage. The search for predictors may be worthwhile even in the early stages of disease.