Implementation of the Results of Laboratory Immunohistochemistry Assay Anti–PD-L1 Using Ventana's Platform: Preliminary Study of NSCLC in 14 Designated National Referral Cancer Hospital in Indonesia

Background: Lung cancer is the most common cancer incidence in population and in hospitals. According to GLOBOCAN 2012 , the incidence of lung cancer in male is 25.8/100,000 with a death rate of 23.2/100,000 while in female 8.1/100,000 with a mortality rate of 7.3/100,000. From the national data, out of 14 provinces (2008-2012) in Indonesia, incidence of lung cancer in male was ranked first, 2.31/100.000. Meanwhile in female was the fifth, 1.08/100.000. Immunotherapy is a novel treatment for many types of malignancy including lung cancer. Currently one of monoclonal antibody against programmed cell death 1 (PD-L1) has been approved for non–small cell lung cancer (NSCLC) with a companion diagnostic by Dako. Ventana's benchmark XT is widely used immunohistochemistry platform. However, data on its reliability and reproducibility with 22C3 antibody in Indonesia are scant. Aim: Immunohistochemistry Dako's anti PD-L1 can be applied in Ventana platform. This protocol could be used in preliminary study for lung cancer in 14 designated national referral cancer hospital in Indonesia. Methods: Lung cancer is the most common cancer incidence in population and in hospitals. According to GLOBOCAN 2012 , the incidence of lung cancer in male is 25.8/100,000 with a death rate of 23.2/100,000 while in female 8.1/100,000 with a mortality rate of 7.3/100,000. From the national data, out of 14 provinces (2008-2012) in Indonesia, incidence of lung cancer in male was ranked first, 2.31/100.000. Meanwhile in female was the fifth, 1.08/100.000. Immunotherapy is a novel treatment for many types of malignancy including lung cancer. Currently one of monoclonal antibody against programmed cell death 1 (PD-L1) has been approved for non–small cell lung cancer (NSCLC) with a companion diagnostic by Dako. Ventana's benchmark XT is widely used immunohistochemistry platform. However, data on its reliability and reproducibility with 22C3 antibody in Indonesia are scant. Results: The Ventana's Ultraview 22C3 optimized protocol stratified the PD-L1 expression. Three out of 10 cases were strongly positive. Some of these had squamous differentiation. Weakly positive was only found in 1 case of adenocarcinoma. The last 6 cases showed negative expression on PD-L1 which 2 of these cases were the specimens from cryosurgery. Conclusion: The results of laboratory immunohistochemistry assay demonstrate than Dako's anti PD-L1 primary antibody can be applied to Ventana's benchmark XT platform. Start conducting study of lung cancer in Indonesia's in 14 designated national referral cancer hospital in provinces profile of PD-L1 expression in Dharmais NCC. The detection of PD-L1 protein expression in NSCLC using Ventana platform can be used to determine which NSCLC patient is eligible for anti-PD1 based immunotherapy.