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The Immune Landscape Of Non‐Small‐Cell Lung Cancer. Utility Of Cytologic And Histologic Samples Obtained Through Minimally Invasive Pulmonary Procedures

Jason Beattie, L. Yarmus, M. Wahidi, P. Rivera, Christopher R Gilbert, F. Maldonado, Kasia Czarnecka, A. Argento, Alexander C. Chen, F. Herth, D. Sterman
Published 2018 · Medicine

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The success of immune checkpoint inhibitors and the discovery of useful biomarkers to predict response to these agents is shifting much of the focus of personalized care for non-small cell lung cancer towards harnessing the immune response. With further advancement, more effective immunotherapy options will emerge along with more useful biomarkers. Paradoxically, minimally invasive small biopsy and cytology specimens have become the primary method for diagnosis of patients with advanced disease, as well for initial diagnosis and staging in earlier stage disease. For the benefit of these patients, we will continue to learn how to do more with less. In this perspective, we review aspects of immunobiology that underlie the current state of the art of existing and emerging immunologic biomarkers that hold potential to enhance the care of patients with non-small cell lung cancer. We address practical considerations for acquiring patient samples that accurately reflect disease immune status. We also propose a paradigm shift wherein the most important sample types that need to be proven in pioneering basic science and translation work and subsequent clinical trials are the specimens most often obtained clinically.
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