Monday, August 10, 2020


Q: 48 years old male with a history of laryngeal cancer is admitted to ICU for airway monitoring due to stridor and hemoptysis. Oncology service ordered Programmed death-ligand 1 (PD-L1). What is its utility?

Answer: The objective of this question is to introduce ICU care providers with fastly rising immuno-therapy in the oncology field. Cancer patients requiring immunotherapy are now frequently getting admitted to ICU. Programmed death ligand 1 (PD-L1) and its partner PD-L2 is a transmembrane protein expressed in normal tissues to inhibit the activity of T-cells and prevent autoimmunity. PD-L1 is commonly upregulated on the surface of tumor cells, binding to the programmed death 1 (PD-1) expressed on tumor-infiltrating lymphocytes, eventually causing a T-cell tolerance. 

This represents one of the various mechanisms of immune evasion. PD-1 inhibitors (nivolumab and pembrolizumab) exploit this immune escape and are now used for various cancers including head, neck, lungs, and gastroenterology cancers.



Inaguma S, Wang Z, Lasota J, et al. Comprehensive Immunohistochemical Study of Programmed Cell Death Ligand 1 (PD-L1): Analysis in 5536 Cases Revealed Consistent Expression in Trophoblastic Tumors. Am J Surg Pathol. 2016;40(8):1133-1142. doi:10.1097/PAS.0000000000000653

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