The other questions I had are basic... like can i go to dentist, etc... think these are the questions that bothered him....

12. Since there was a change in my cancer, does this mean I am no longer pdl-1 less than 1 % and what exactly does pdl-1 less than 1 % mean as opposed to higher numbers and or mutations?

13. https://news.yahoo.com/moves-medicine-never-smokers-develop-200303715.html
Is stating that they find that especially in non-smokers that estrogen level may have a factor in these women getting lung cancer. I went through the change of life for 14 years.. think that could of contributed to my cancer even though I had been a smoker? Do we know what caused my cancer? Can you tell whether it was caused by asbestos or smoking, etc..?

15. As far as I know my first oncologist sent my tissue Biopsy to Princess Margaret Hospital to see if I would qualify for immunotherapy before starting me on chemo in hopes I would qualify… not sure why I did not qualify then, but do now… however, was the Test Bio Marker testing?
• And was I tested for the different types of cancers below?
• And is this how they know I am PDL-1 less than 1%?

'THIS WAS A GENERAL STATEMENT I COPY AND PASTED FROM SOMEWHERE, JUST WANTED TO KNOW IF I WAS TESTED FOR ALL THESE DIFFERENT TYPES OF CAANCER)
(Molecular diagnostics result from Princess Margaret showed that they tested for AKT1, BRAF, (/EGFR, ERBB2, KRAS, PIK3CA, RET and TP53 through Next Generation Sequencing, and ALK, ROS1 through immunohistochemistry, and PD-L1 as well. All samples were taken through fine needle aspiration.

16. I have been having which seems like muscle pain in my upper arms in the front… should we be checking my CK(Creatine Kinase) levels.. Seen this on a support website of someone else who was going through immunotherapy..see their statement below:
Jill Nolan Morris I had a severe reaction to Keytruda. I ended up with rhabdomyolysis/myositis. Basically my immune system attacked all my muscles resulting in severe muscle wasting. I am 5’8” and got down to 98lbs. I could barely walk, talk, eat or drink. I looked like I’d had a stroke.

You need to have the doctor pull his CK level (creatine kinase). CK is the muscle wasting enzyme produced by the wasted muscle.

It took a week in the hospital before they figured out I was having a reaction to Keytruda. I was put on 100mg of prednisone and it took almost 9 months for me to recover

17. Should that cancer/research center offer a targeted treatment plan or clinical trial that you don’t offer, would you be willing to collaborate with them for follow-up care?

18. I try hard to understand my cancer.. Mutations versus no mutation.. how was it determined that I have no mutations and am pdl-1 less than 1 percent.. was this determined through bio marker testing? Should I have bio marker testing again to see if my cancer changed? Would the blood biopsy I had in November in London show what changed? I was told I was not eligible for the CAPTUR trial.. (see attachment of what the trial was regarding).

*** Trying to understand my cancer:

What are checkpoint inhibitors? Is this immunotherapy drugs that inhibit the proteins which are called checkpoints (in this case my protein is called (PDL-1/checkpoint) from causing more cancer)?
What is an example of an immune checkpoint inhibitor?

A type of drug that blocks proteins called checkpoints that are made by some types of immune system cells, such as T cells, and some cancer cells. ... Examples of checkpoint proteins found on T cells or cancer cells include PD-1/PD-L1 and CTLA-4/B7-1/B7-2. Some immune checkpoint inhibitors are used to treat cancer

What drugs are immune checkpoint inhibitors?

Checkpoint inhibitor drugs that target PD-1 or PD-L1
• Pembrolizumab (Keytruda)
• Nivolumab (Opdivo)
• Cemiplimab (Libtayo)
•
What is checkpoint immunotherapy?

Checkpoint inhibitors are a type of immunotherapy. They block proteins that stop the immune system from attacking the cancer cells.
Cancer drugs do not always fit easily into a certain type of treatment (Not sure how this sentence fits in to the above statement)??

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