Next generation sequencing is increasing in daily clinical practice and in consequence so is the determination of TMB. However, TMB can only be assessed in half of NSCLC patients and just one-third has high TMB. Assays and definitions for high TMB should be standardized in both tissue and blood. Indeed, the real predictive value of high TMB over its prognostic value merits further evaluation. Despite the efficacy of nivolumab plus ipilimumab in selected patients according to the high TMB, compared with other strategies in the first-line setting, no survival benefit has been reported with the combination of nivolumab and ipilimumab; some patients may present hyper-progressive disease on treatment despite being selected for a predictive biomarker, and the cost of the potential biomarker for this combination is higher than PD-L1 immunohistochemistry expression as well as the toxicity profile. These limitations may limit broad acceptance of this combination in the current strategy of advanced NSCLC patients.


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The authors report no conflicts of interest in this work.

Jordi Remon,1 Laura Esteller,1 Álvaro Taus2,3
1Centro Integral Oncología Clara Campal Barcelona, HM-Delfos, Medical Oncology Department, Barcelona, Spain; 2Hospital del Mar, Medical Oncology Department, Barcelona, Spain; 3Oncology Department, Cancer Research Program, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain


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Source: Cancer Management and Research.
Originally published May 29, 2019.

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