What Your Score Means for Your Treatment Options
Here’s how CPS ranges are typically used to guide treatment:
CPS Less Than 1 (Negative)
A CPS of less than 1 means PD-L1 was not found at a meaningful level in the tumor cells or surrounding immune cells. In this case, immunotherapy alone is unlikely to work, Reyes says, and a chemotherapy-based approach may be recommended instead.
That said, a negative score does not completely rule out immunotherapy. “There are still some patients who have some benefit from immunotherapy drugs even though their PD-L1 test is negative,” says Yorio.
CPS 1 to 19 (Low Positive)
A CPS between 1 and 19 means PD-L1 is present but at a lower level. While immunotherapy can be used in recurrent and metastatic head and neck cancer when CPS is above 1, it tends to be less effective when the score is below 20, says Reyes.
CPS 20 or Above (High)
When a CPS comes back at 20 or above, it suggests the cancer may be using this protein to stay hidden from your immune system.
“High scores can indicate the benefit of single-agent immunotherapy,” says Reyes, meaning an immunotherapy can be used without chemotherapy. Research shows that people with higher CPS scores are more likely to respond well to immunotherapy alone.
Other Factors
Your PD-L1 score is only one important piece of the decision. Gogineni notes that, when putting a treatment plan together, your care team will also consider factors such as:
- Your overall health
- The extent and location of the disease
- Whether your tumor is HPV-positive (a virus that can cause certain head and neck cancers and may affect how the cancer responds to treatment)
- Previous treatments received
- Your goals and preferences
If you aren’t feeling well enough to handle the demands of combination therapy, immunotherapy on its own can still be an option, says Reyes.
The Takeaway
- PD-L1 is a protein that some cancer cells use to avoid being attacked by your immune system, and testing for it helps your care team understand if immunotherapy may be a good option for you.
- In recurrent or metastatic head and neck cancer, the PD-L1 score helps guide whether immunotherapy will be used on its own or combined with chemotherapy.
- Higher scores are more likely to respond to immunotherapy alone, while lower scores may still benefit from treatment but often require a combination approach.
- Your PD-L1 score is just one part of the decision. Your oncologist will also consider your overall health, prior treatments, and other factors to choose the best plan for you.
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