Not eligible for Immunotherapy. Now what?

This is what I’ve just found:

“A PD-L1 test uses a sample of cancerous tumor tissue to measure how much of a protein called PD-L1 is found on the cancer cells. If you have certain types of cancer, PD-L1 testing can check whether you may benefit from a type of cancer treatment called immunotherapy.”

So it seems that immunotherapy only works if you have/had PD-L1 in your cancer cells?

I don’t know if my husband’s original LC tumor had PD-L1 cells. And altho the mass on his adrenal glad thought to be LC metastasis, the biopsy sample did not report cancerous cells. So I do not know if he qualifies for immunotherapy.

I'm also confused by this. My oncologist works a lot with immunotherapies at UCSF and he's told me I'm still a candidate for Keytruda even though they couldn't find any biomarkers and there is no evidence of PD-L1. I can't find much information on the internet about being successfully treated with immunotherapy drugs if you don't have biomarkers.

I found situations when Keytruda can be used. Many do not mention PD-L1. I think the below applies to my husband.

“KEYTRUDA is a prescription medicine used to treat a kind of lung cancer called non–small cell lung cancer (NSCLC).
- It may be used with the chemotherapy medicines pemetrexed and a platinum as your first treatment when your lung cancer has spread (advanced NSCLC) and is a type called “nonsquamous” and your tumor does not have an abnormal “EGFR” or “ALK” gene. “

Here’s the link:
https://www.keytruda.com/keytruda-faq/

I found situations when Keytruda can be used. Many do not mention PD-L1. I think the below applies to my husband.

“KEYTRUDA is a prescription medicine used to treat a kind of lung cancer called non–small cell lung cancer (NSCLC).
- It may be used with the chemotherapy medicines pemetrexed and a platinum as your first treatment when your lung cancer has spread (advanced NSCLC) and is a type called “nonsquamous” and your tumor does not have an abnormal “EGFR” or “ALK” gene. “

Here’s the link:
https://www.keytruda.com/keytruda-faq/

Thanks for this, I had seen this on their website, but I'm still a little bit confused... does this mean it can only be used in conjunction with a platinum-based chemotherapy and not just by itself?

My oncologist doesn't seem to want any surgery performed because he says it will create "too much tissue loss," I'm assuming because I've had extensive radiation in the past and they're concerned also about fibrosis as a result of that. I've never gotten a clear answer. I had a pulmonary finction test about five years ago and the results showed some slight COPD (yes, I was a previous smoker), but I'm on the ellipticals at the gym for 25 minutes 3 days a week with no difficulty. We have talked about ablation, but my radiologist has said that they've seen mixed results with it. I'm meeting with my oncologist on Wednesday morning, I'm going to try and get more information.

I would ask for a new pulmonary function test, five years is a long time. It will tell you what capacity you have lost with the treatments, etc. They are simple and not expensive. Fibrosis (scarring) can be caused by many things including radiation and lung does not repair itself. I attach an article from Mass General - note page 18 "Percutaneous Ablation of Lung Tumors"
Does your Oncologist discuss your case with a Tumor Board?

My oncologist brought my case up to the tumor board and they concur with him. I also got a second opinion from another oncologist who's at Stanford, who also said he would treat me in the same manner as my oncologist. I'll ask my radiologist about scheduling another PFT... I really hate doing them, I have to consistently blow into a tube over and over again for 45 minutes until I start getting dizzy. Re: the attachment re: ablation, I'm not seeing an attachment. Do you possibly have a link to the paper? Thanks very much for all your info, by the way.

I swore I attached the article! Anyway here is a link to another article that talks about ablation (always for people with interstitial disease -like me now). https://www.ajronline.org/doi/10.2214/AJR.23.30300#:~:text=Percutaneous%20ablation%20appears%20to%20be%20safe%20and%20effective%20for%20stage,)%20%5B1%2C%202%5D.
Regarding the pulmonary function test, I know they are boring - I have done five in the last year. But do you have a pulmonologist? My Radiation Oncologist righty says she is not a Pulmonologist. PFTs are not that easy to interpret
even if the report provides summary. They can indicate the difference between COPD and some other type of pulmonary disease. But if you go to the Pulmonary Fibrosis Foundation Internet page they have a document which explains PFTs.

Thanks, I was able to read the ablation paper from the link. This makes me wonder why the procedure isn't used more often. I don't currently have a pulmonologist, I'll check out the PFT internet page.