Nivolumab aka Opdivo

Nivolumab was the first immunotherapy used in lung cancer. There have been many more since.

If you are to have chemo, they will likely go with standard of care which is carboplatin and bevacizumab (Avastin) with the immunotherapy drug keytruda.

@zora0121, there are several discussions in the Lung Cancer support group related to Opdivo (nivolumab). You may find these helpful:
- Anyone on Opdivo (nivolumab) for metastic lung cancer?
https://connect.mayoclinic.org/discussion/opdiva/
- Did you have a serious reaction to Opdivo (nivolumab)?
https://connect.mayoclinic.org/discussion/reactions-to-opdivo/
- Has anyone had the Opdivo (nivolumab) / Yervoy (ipilimumab) protocol?
https://connect.mayoclinic.org/discussion/opdivo-yervoy-combination/
What treatment will you be receiving?

At this point I'm just scheduled for chemo with
Pemetrexed and cisplatin.
I am wondering about receiving immunotherapy in addition to chemo, given my Kras G12D status. It appears I should've been given this perioperatively. Studies give much better result if given pre resection. I'm wondering if there is any data post operative given my stage 2a status?
Seems like everything is for stage 3 or 4 if postoperative???

Hi @zora0121, Unfortunately, the research doesn't always keep up with our needs. I'm not an expert, I'm a patient with the ALK mutation. Just because it hasn't been researched and documented doesn't mean that it won't be beneficial for your 2a stage. Have you started the chemo? Have you asked your team about the possibility of immunotherapy?

I'm on a 4 cucke chemo, just had my 2nd treatment. Unfortunately my oncologist is unwilling or unable to talk to me about Kras mutation, he said 40 percent of cancers have this mutation. Not an issue at this time, promised some creating material never provided it. When I tried to ask about immunotherapy he was very dismissive. We won't talk shout that now, only if it's metastatic..
I have requested a new referral, I'm in Canada and our healthcare has deteriorated unbelievably in the past 8 years.
I do not feel my current oncologist and I can have a meaningful discussion about my care. I'm concerned obviously about that...

@zora0121, I'm sorry that you are having to work through this challenge on top of everything else that you are facing. Is there a nurse, or someone, in the office that can provide the materials that you were looking for? They may have more time to respond to direct patient needs.
From what you've described, you may be denied a change in provider. Unfortunately, learning to work with him, or around him, may be necessary. Do you know how long it takes to hear about the referral?
I'm not sure if this is helpful, but the Lung Cancer Canada group is fairly active. They offer Heathcare Navigation Support related to requests for second opinions.
https://www.lungcancercanada.ca/en-CA/Resources/Support.aspx

Has there been any pathological studies done for your tumor for immunetherapy candidacy?

The way anticancer drugs work is that they make the cancer cells "visible" to your immune system, enabling your immune cells to attack the cancer. This is the case for example if PD-L1 was positive in your cancer. The drug would inhibit PD-L1 of your tumor cells and T cells would attack them.

It is entirely possible that your cancer has tested negative for these proteins and therefore the drugs would unlikely work for the cancer. This is true particularly if there are immune cells among the tumor and the tumor tested negative for the proteins.

These drugs can also cause severe side effects as they can cause your immune system to attack healthy cells. Also if your tumor has negative tests, it might mean that in order to get benefit from drug like Nivolumab, it might need to be combined with something like ipilimumab, and even then there is less chance that the therapy works. Unfortunately these combination therapies are also very expensive treatments.

I would ask about the pathology results, did they do any tests for immunetherapy and specific reason why they advice against the drug.