Considerations for Immuno-Oncology Testing

Immuno-oncology (IO) is showing significant promise in treating cancer patients where other approaches have failed. As breakthroughs in IO continue to revolutionize cancer treatment, pathologists and laboratory professionals—particularly those who practice in smaller, community-based settings--are challenged with staying abreast of all the new testing protocols, diagnoses, and therapeutic treatments.

“Community-based pathology groups may not be using IO therapy with as much frequency as those in major, academic medical centers,” says Stuti Shroff, MBBS, PhD, a member of the ASCP Immuno-Oncology Work Group. “Also, there are a lot of advertisements on TV that encourage patients to ask their doctors about this drug or that drug. Patients may not realize that IO therapy is not a magic pill. There are specific selection criteria. And, on the back end, there are some significant medically-related side effects.”

Given the rapidly evolving nature of the IO field, the ASCP IO Work Group has created a comprehensive educational strategy to guide the development of education that will enhance the knowledge and skills of today's pathologists and laboratory professionals. In addition, the IO education supports the implementation and dissemination of best practices in IO testing, treatment options, and communication in multidisciplinary teams to improve quality of care.

“At the pathologist level, we must make sure that we identify patients who could be suitable candidates for this therapy. This determination is based on expression of specific proteins by cancer cells and immune cells in the cancer microenvironment. Expression of these proteins is tested by performing immunohistochemistry (IHC) on the tumor tissue. This enables us to determine which patients will likely show a therapeutic response to this IO therapy,” Dr. Shroff says.

There are cut-off points for each immunohistochemical assay that vary based on tumor type and that enable pathologists to determine whether a patient will respond well to a particular immunotherapy.

At the clinical level, treating clinicians should be able to rule out if the patient has any auto-immune or other conditions that would make them unsuitable for immunotherapy.

ASCP’s IO Work Group, whose members hail from various professional backgrounds, has been reaching out to pathologists and laboratory professionals at the community level to identify the barriers to effective implementation of these new therapies. Learn more about ASCP’s IO education by clicking here.