Publication:

Evaluating the landscape of PD-L1 testing and treatment approaches in gastrointestinal and lung cancer: a questionnaire-based study among Indian oncologists

Background Lung and gastrointestinal (GI) cancers together account for a major proportion of India’s cancer burden, with most cases diagnosed at advanced stages. Despite the proven efficacy of immune checkpoint inhibitors (ICIs), access and biomarker-guided implementation remain limited. This study assessed the current landscape of PD-L1 testing and immunotherapy (IO) practices among Indian oncologists treating patients with lung and GI malignancies.

Methods A cross-sectional, questionnaire-based survey was conducted among 63 practicing oncologists across India from February 2025 to April 2025. The 23-item questionnaire collected information on PD-L1 testing practices, immuno-oncology (IO) usage, and barriers to adoption. Data were analyzed using descriptive statistics.

Results Most respondents (73.02%) had over 10 years of clinical experience. PD-L1 testing was most frequent in non-small cell lung cancer (NSCLC) and less consistent in GI malignancies. Immunotherapy use was highest in NSCLC (44.44% common use in first-line) and hepatocellular carcinoma (36.51%), but infrequent in colorectal and biliary tract cancers. High PD-L1 expression guided IO use in most cases, while actionable mutations and performance status also influenced treatment choice. Cost was the predominant barrier, with 56-70% of patients deferring IO due to financial constraints. Key unmet needs included affordable access to IO (95.24%), predictive biomarkers (58.73%), and India-specific clinical guidelines (57.14%). Experienced oncologists were more likely to consider IO re-challenge after progression (p=0.03).

Conclusions PD-L1 testing and IO adoption remain inconsistent across India, primarily due to cost, infrastructure, and limitations in biomarker availability. Strategic measures such as subsidized access, standardized testing, and context-adapted guidelines are essential to advance equitable precision immunotherapy in Indian oncology practice.