Tom Galli

@Karen_LThanks for the very kind words.
@JuneKThanks. We are probably in the same boat now with the progression. Happy to hear that you found a targeted gene for which there are treatment options. Good luck, my prayers are with you.
So an update after meeting my onc-doc. He said the progression was real, but local. No more psuedo-progression. But Alimta and Keytruda are no more working. So I have been switched to Paclitaxel/Carboplatin/Becavizumab regimen for the next 6 cycles, with scans after every 3 cycles. Platimum treatment worked for me in the first round before it was removed during maintenance therapy, so the doctor feels it will help contain/minimize the growth this time as well. If this works, then they will stop Paclitaxel/Carboplatin after 6 cycles and continue with Becavizumab from then on. If not, Docetaxel would be the way forward.
The doctor also suggested molecular testing, but was not persistent on it. He does not think there will any ALK/ROS/EGFR mutation now. He thinks because immunotherapy worked for me for almost 20 months, it is highly likely ALK/ROS/EGFR mutations are present.
Since molecular testing is not covered under insurance here, and more so, technicians/pathologists are not well trained in performing the test or reading the results, there have been lot of cases of false positives/negatives. Have a friend who is a molecular oncology geneticist who does this for a living, specifically for lung cancer. He himself says that he would not trust the results from these molecular testing studies most of the time, as he has seen a lot of such false positives/negatives. Will give it a try anyways.
Anyone here have an idea on the side-effects of Paclitaxel/Becavizumab. The doctor told me issues of high BP/palpitation and neuropathy (tingling of hands and legs etc.), but other than that, what can one expect.
Any information will be helpful. Thanks.
GBJ
 

Such wise words Karen - I agree with you completely! I sometimes find myself slightly annoyed when a well-meaning friend tells me I have to remain positive. My first thought is always, "well, that's easy for YOU to say". It's just one more thing to feel bad about - am I a failure because I struggle to remain as positive as I should while fighting this disease?
GBJ - I experienced a recurrence this summer so I know how devastating it can be. Especially when things had been going so well for a while. I hope that's not what is happening with you, but if it is, I will pray they find the best treatment options for you going forward.

@GBJ You know, IMO, this "be positive" cancer thing is sometimes more pressure than we need. Just sayin'.
This may seem to be heresy, but it's beyond me how a human can feel positive about something as scary.
We all make peace with our situations in different ways. But I am never positive about lung cancer. I think it's stupid and unfair.  When there's a change in my disease, I'm numb. After a little while, I feel a reprise of the emotions I had with my initial diagnosis: I feel angry and frightened and full of grief.
Eventually, I choose to say, "OK, that's how I feel. I see that, and now I'm going to re-examine my day-to-day and see what I might need to do to make a meaningful life within the new parameters." Sometimes things happen quickly enough that I have to juggle feelings and actions at the same time. That's when I go to my primary defense: dark humor in the face of the absolute absurdity of the situation. But all that other stuff is stewing in the background. It's exhausting. 
Just take care of yourself in whatever way you need to. Each day, find one thing, anything, that brings you peace or pleasure, or even a laugh. Take a deep breath, take a couple, when you feel afraid. Unless it's helpful to you right now, you don't have to be positive. You just need to cope. 
We're here. Keep us posted. 
Karen

Thanks Tom and Karen.
Meeting with the oncologist today. Will know more what he has to say. Will surely ask for molecular testing (rare in India) and about radiation therapy (SBRT is rare in India)
The results are a huge setback. Trying to be positive in all of this.
GBJ

Unfortunately, I suspect lung cancer is just doing what lung cancer does. At webinars, I've heard doctors discuss their research; some have a "cancer seed" theory, that lung cancer appears to be gone but seed cells remain and are sparked into action. Their research focuses on identifying and interrupting the triggering processes. 
Just curious-- have you had biomarker testing? Sometimes knowing about mutations of your specific cancer can help you understand your doctor's thinking. In many countries, there are treatment protocols in place for different iterations of the disease.  Having some knowledge of these can help you open discussion with your doctor about steps moving forward. Here's an example of guidelines for NSCLC in the U.S. In a recent webinar, one researcher said that while U.S. doctors aren't bound to these protocols, insurance may not pay for novel approaches. I believe European nations have such guidelines; I don't know if guidance like this exists where you are.
In the U.S., we speak about seeking a second opinion from a different lung cancer specialist. Perhaps that is possible in your country? In instances of recurrence, we also speak about re-checking biomarkers to see if your disease has developed new mutations. There are liquid biopsies that can 
For me, it's important to remember that lung cancer is persistent and effective at working around our interventions. This is why research is so critical to forwarding treatment. 
I hope something in my response offers a way for you to better understand your situation. 
Karen

Wow, BryJ, that's quite an adventure you've had! Seems like the nurse pulled the tube prematurely. I was sent home the day after my VATS lobectomy with the dreaded chest tube in place, connected to a one way valve and a bag. They said it needed to stay in until air stopped coming out. This took about 10 days. It was kind of a drag but nothing like what you went through. 
I'm glad to hear you're cancer free and I hope you  have no more adventures in leak-land.

Another update from CancerLand. My wife is doing great. She's healed well from surgery and is now into chemo. Her hair is beginning to fall out and she's planning to get a buzz-cut tomorrow. A resource you may not know about: Any Great Clips salon will give a free buzz-cut to anyone whose hair is falling out from chemo. 
My friend with myelofibrosis is feeling more hopeful--she's on some new meds to help keep her red blood cells up. However, she tripped over one of her granddaughter's toys in the dark and now has a dreadful looking black eye.
My other friend who's in hospice is getting good support from her hospice providers and is fairly comfortable. She can no longer cook and her husband, who is near 90 and an incredibly sweet man is having a hard time dealing with that and everything else.  She now has a MealTrain, and I've offered to help them sign up for Meals on Wheels. 
Unfortunately, I've had to cut contact with my former co-worker, the Hamburger Helper person, because his issues exceeded my bandwidth at this time. He really wanted to get out of the nursing home, although he couldn't care for himself. He didn't want help getting a case manager or social worker involved, but rather wanted help getting his cash out of the bank, I think so he could plot an "escape."  
And, as for me,  I was hospitalized earlier this month for a small-bowel obstruction. I had a Stage 3 gynecologic cancer diagnosed in 2011 and I'm grateful to be NED., but  I've had a bunch of late-occurring side effects from the aggressive treatment that saved my life. The most recent is these small-bowel obstructions that started just before the pandemic, apparently from adhesions and strictures caused by the surgery and radiation. Treatment included a naso-gastric tube hooked up to suction to relieve pressure by removing by the "upper route", the contents that can't escape via the "lower route" . I tell you, it's worse than a chest tube!  But I've recovered from the obstruction and the tube. I'm scheduled for an MRI to see what my digestive system looks like when it's not in acute distress. I'm also on a restricted diet and will be seeing a nutritionist to fine-tune it. Ahh, cancer- the gift that keeps on giving. 
I'm taking a couple of months off from work to deal with all of the above.  And, by the way, the kitty is fine!
 
 
 

Here I am, over a month later since my last update and I'm doing great! I'm back on my regular diet (although I have to admit I still watch my fat intake so as to maintain my boyish figure ) Doing all my normal activities again and no breathing issues
Next CAT scan is due at the end of October and hopeful things remain good.

Hi June,
Wow! That's incredible. I also have the Ros-1 mutation. I'm sure you've joined the Facebook group. It's an amazing resource. https://www.facebook.com/groups/ROS1cancer
I'm not the most typical Ros-1 patient because I was stage 3b and had the more traditional treatments (cisplatin and alimpta + radiaiton) in the hopes of a cure. Those treatments have been successful so far and I'm not on any treatment now. I did try Entrectinib immediately after completing my treatments, but since the side-effects were so harsh, I decided, on the advice of my oncologist, to stop. I would have persevered if I wasn't NED at the time. I always hear that as your body adjusts, the effects become much milder. It's also true that many people who have difficulty with one TKI drug do well with another, and incredibly there seem to be quite a few effective drugs. The newest Nuvalent trial drug (NVL-520) seems to be quite effective with very few side effects. We're on the cutting-edge of science!  
Good luck with these next steps! 
Karen

I am also a caregiver, the son of a patient, and I understand the unimaginable human difficulties when what we want makes the patient afraid.  Non-cooperation, denial, running away... exhaust us every day, but let's sympathize with them, because we are not patients.  I pray for you.  Please maintain your health and spirit.  Your brother is already a miracle in SCLC (with just standard chemotherapy and radiation), and you are also a great person.  This is strictly the patient's fight, but when a patient has cancer, it is the fight of the whole family, of those who love the patient.  
I pray for both of you.

I have had an amazing turn of events these last few days! My oncologist had ordered more genetic testing a few weeks ago, just to make sure nothing had changed before we started the new chemo. The testing company had delays for some reason. But both my oncologist and my Emory doc agreed we should delay the chemo until results came back.
So last week’s treatment was delayed while we waited. The delay was stressful in itself as the cancer appears to be growing fast now. Then lo and behold, doc called Wednesday evening saying the results were back, and this time it shows I have the ROS-1 mutation! And there is a targeted drug I can take! I almost couldn’t believe my ears. I still can hardly believe it. This mutation is rare – only about 1% of lung cancers are ROS-1. I will be starting Entrectinib next week – my insurance approved it today. It is not a cure, as everyone eventually develops resistance. But there are already 3 other drugs in trials for use after resistance.  
Not everyone responds to Entrectinib, but the response rate is pretty good – something like 70%. Seems it can keep things in check for anywhere from 6 months to 4 years. I can’t tell you how wonderful it is to have my small window of hope opening up a little bit bigger!
This mutation is so rare my oncologist has never had a ROS-1 patient before. So we will stay in close contact with the Emory Winship doc. Whenever this drug fails, she can help get me on clinical trials for one of the newer ones.
Entrectinib does have some bad side effects. I’ve already been poring over the ROS-1 forum. Most say the side effects are worse the first couple of months and then your body starts adjusting to it. Surely it can’t be as bad as chemo, so I say bring it on!
I am puzzled why this wasn’t detected last year with the initial testing. What’s really weird is the KRAS that was detected last year did not show up at all this time. I remember we had problems with failed biopsies and then a sample being rejected for some reason. I believe the KRAS was detected from my blood biopsy. I guess it doesn’t matter now, but wondering if maybe they weren’t thorough enough in the beginning.
Thank you all for your concern and for letting me vent my worries as things have played out. It will be interesting to start this new journey. Does anyone know if there are any other ROS-1 people here on Lungevity?
Best to all,
June

June,
I'm following your treatments. Stay the course!
Tom

June,
I'm following your treatments. Stay the course!
Tom

@BryJ, is it even possible to respond to your tale? I'm sitting here with my mouth open, thinking of all the stuff we don't know until it happens.
I admire you for speaking up about your chart notes and getting food instead of a chest tube.  And, I can relate to ER regrets. Mine was about a pulmonary embolism. I learned that when they say, "We'd like you to go to the emergency room," it's not a question, it's a directive. Ah well, next time.... 
Glad to hear your wife is getting patched up. 
Glad to hear they got all the cancer. 
It's good to be alive, eh?
K

This is the outcome of my diagnosis and surgery that I talked a bit about in my newcomer's post. Oddly enough, the right thoracoscopic lower lobectomy and mediastinal lymphadenectomy was the easy part...
I had surgery on Monday and was released from the hospital on Tuesday. There was some confusion prior to my release Tuesday morning regarding my chest tube because it bubbled like crazy every time I coughed. After five nurses looked at it, a sixth nurse came in with a student and rather arbitrarily pulled the tube and stitched me up. Shortly after this happened, however, the thoracic surgeon's physician's assistant came in the room and was somewhat upset that the chest tube was already out.
Now, one of the odd things I noticed immediately after they pulled the chest tube was that every time I coughed (or even cleared my throat) a huge bubble--probably a good six- or eight-inches across--would appear under the skin over my upper incision site and then it would seep back to wherever it came from. This was kind of weird. The nurse I told about this (same one who pulled my chest tube) didn't think it was anything special, so away I go home, alternately inflating/deflating depending on how hard I was pushing air out of my chest.
Tuesday evening at home wasn't bad--I learned to brace myself in an old wing-backed chair we have to try and splint where the bubble popped up every time I coughed, which kind of helped, and I started developing an awesome case of crepitus in my upper right chest and the right side of my neck. So crunchy... and my voice got really weird. This continued through Wednesday, to the point where I called the surgeon's office Wednesday afternoon and again complained about the air bubble and asked about the crepitus. The physician's assistant I talked to told me this was a normal outcome of the surgery and I should only worry if I started having trouble breathing or difficulty swallowing.
Okay, I just had part of my lung removed, of course I'm having trouble breathing. That was not a useful diagnostic tool, thank you.
I could still swallow okay, and what trouble I was having I attributed to dry mouth conditions caused by oxycodone, which I was still taking at that point. So Wednesday passed in a wheezy, crunchy and still inflatey/deflatey way.
However, when I woke up at 2 a.m. Thursday morning things felt weird. My heart was jumping around in my chest--it felt like I'd had a couple Black Tiger milkshakes and two double-chocolate donuts from the way things were leaping around in there. I kept trying to go back to sleep and it kept waking me up and I just chalked it up to another strange drug interaction, probably with the oxy. This kept going until 6 a.m when I thought that I'd run an ECG on my Apple Watch and see what happens. 
Heart rate: 131 beats per minute, possible atrial fibrillation, "you should talk to your doctor soon."
Huh? My normal resting heart rate is around 52-55, so 131 is a bit high for me. I check through all the after-visit summary documents they gave me and the only warning signs they have are:
Fever higher than 101 degrees F Redness, increasing pain or swelling around your wound Cloudy or bad-smelling liquid oozing from your wound Sudden or severe shortness of breath Nothing about high heart rate. Hmm. 
Like an idiot, I wait another HOUR before mentioning to my wife, "Hey, my heart rate's pretty much tripled since yesterday..." (Keep in mind that my wife has two broken arms due to slipping on a curb while I was in surgery, so she's already got her own stuff going on. And here I'm just adding to the pile with my silly heart thing...)
So she and my daughter throw me in the car and zip me off to the local hospital's ER, where I discover the great word PNEUMOTHORAX: "A pneumothorax is a collection of air outside the lung but within the pleural cavity. It occurs when air accumulates between the parietal and visceral pleurae inside the chest. The air accumulation can apply pressure on the lung and make it collapse."
It can also put pressure on the heart and cause it to get angry (so to speak), and one of the ways the heart expresses this irritation is by speeding up. Yay. This is NOT covered in any of the recovery documentation.
So there I am in the ER and they're trying to figure out what to do with me. They'd like to ship me back to Providence, where my surgery took place, but Providence is currently rerouting new patients to other hospitals in the region because they're full. They'd really like to put another chest tube in me, but they need to do it under CT guidance because the recent lobectomy has changed the internal layout of my chest and they don't want to make a mistake--and they can't find anyone at the hospital willing to do it. So I languish in the ER for almost 10 hours before they find a radiologist willing to take a chance on me and they wheel me off to get uncorked.
While I'm talking to the radiologist I find out that I shouldn't be sitting up and talking to ANYONE at this point--apparently a collapsed lung is supposed to be extremely painful? I can't tell--aside from the extremely rapid heart rate, I felt pretty much normal. Go figure.
They run me through the CT a few times, draw target lines on my side, and zowie holy Toledo I do NOT like people sticking big needles into my chest cavity even with lidocaine. Yeah, both the needle biopsy and the new chest tube (even though it was only about the same diameter as the ink cartridge in a ballpoint pen) definitely fall into the category of "No thank you, please don't do that to me while I'm awake" procedures. Yuck.
They wheel me off to a room (hooray!) and the on-staff pulmonologist shows up and hooks me up to an "Atrium Oasis Dry Suction Water Seal Chest Drain" and holy smokes look at all that fluid just gushing out of me. Yeesh. And it's BRIGHT RED. OMG. So they leave me there overnight, X-ray my chest at 5 a.m. and find that while the fluid's drained well it hasn't touched the air in my chest, but the 11 a.m. X-ray shows the air is pretty much gone at this point and my heart is now sitting around 70 bpm and I'm feeling a lot better. Silly me, I think I get to go home now...
Nope. Providence has a bed open, so at 7 p.m. they ambulance me from my local hospital (which is only about three miles from my house) to Providence, a good 40-minutes away. Sigh. My wife can't drive (two broken arms), so this has a significant impact on her because now she's trying to find rides to and fro to visit me.
I end up back on the respiratory ward at Providence and the nurses are getting me ready for a 12-hours fast so I can go get a new chest tube place and I'm, "Hey, they told me that my 11 a.m. X-ray shows the pneumothorax was reduced and that things were looking good", so everyone finally slowed down enough to check the chart notes I came with and I avoided another chest tube. And they let me eat something, which is what I was really after.
And so I sat in a hospital room at Providence and had some really great conversations with the nursing staff all day on Saturday and Sunday and half of Monday before they finally kicked me to the curb. I learned a lot--it turns out that there are patients in the respiratory ward who are not there voluntarily. For example, there was the "this is bullsh**" guy two doors down who threw things, and the gal across the hall from him who had a similar and slightly coarser vocabulary but who didn't throw things. And there was the gal across the hall from me who was suffering from addiction who liked to stand in the hallway and shout "Help me!"
I kept my door closed a lot.
All in all, this was a really odd experience. I'm guessing the pneumothorax put my recovery off by about a week. I would have gone to the ER a lot faster if I'd had a little more information about pneumothorax symptoms. I am really impressed with the staff at Providence and can't believe what the patients put them through--and yet they were without exception really nice and incredibly friendly to idiots like me who, due to boredom, wanted nothing more than to chat at 2 a.m. about dogs and cats and why box squats are great exercises.
The great news out of all this is my follow-up with the thoracic surgeon on Tuesday morning. I am now cancer-free--a 1.9cm tumor was removed, margins are clean, and there was no sign of cancer in any of the lymph nodes they examined. I go in for a baseline CT scan in four months, then scans every six months for two years, then one a year for a while after that. I really can't get over how fortunate I was that this was found so early and how quickly they got it out of me. Wow. 
And my wife has surgery this morning to reattach her left hand to her arm, so things are looking up there as well.

Hi All, it been a while since I posted on this site. Dx with Stage IV A adenocarcinoma Lung in Feb 2022, have completed 6 cycles of carboplatin, 25 of Alimta and 24 of Keytruda by September 23. Have been on maintenance therapy - carboplatin dropped - since July 2022. First 3 scans taken until April 2023 showed significant regression in nodes and lesions, almost 90% gone.
PET scan taken in July showed increase in size and SUV by a few mm, same location. No new location found as per the oncologist. Since I have been on immunotherapy, the oncologist was thinking it is more likely a pseudo-progression caused by the immune cells generating a response rather than growth. He has asked for continued treatment with Alimta and Keytruda for the next 3 cycles, with a follow up scan. He said, since I do not have any other symptoms and all my blood markers are normal, it should be okay.
Another PET scan taken this week. Results are back with further increase in size and metabolic activity. Also new lesion detected in D2 spinous process. Awaiting doctor's appointment.
The size of tumor increase is only 1-2 mm in some places, and some nodes have either regressed or are persistent. Physically as active as ever with no major heath concerns. The progression is localized and has not spread to any other organ. Unable to understand what is going on.
I am not sure if the doctor will start second line therapy.
Any ideas what I need to expect from here on. Just wanted to get a feeling of my options.
GBJ

I am very saddened by the difficulty we have these days in discerning science from politics. In science, there are no absolutes. Nothing is settled. Ever! Period! We learn from postulating hypotheses and subjecting hypotheses to tests and investigations (called experiments) to prove or disprove the hypothesis. Proving does not establish an absolute truth and does not stop the scientific process. Proving yields a theory, but a theory is not an absolute fact. All theories are subject to further scientific exploration. 
Anyone who tries to convince you that science is settled is a politician. And political science is an oxymoron! Even worse than oxymoronic politicians are broadcast journalists who are just plain dumb!
Stay the course.
Tom

As a a coda to Lily's comprehensive explanation of the COVID risk and downside, consider that most of us live in free societies. Freedom is a right, not a duty. We have the absolute right to protect ourselves, but we do not have the right to expect others to conform to our protection measures. We seem to have forgotten this and thus protection strategies, vaccination and the like became a "political issue." 
I have a high mortality risk for any pulmonary malady, especially COVID. To live, I have to take measures to protect myself. Outside of the confines of my homestead, I can't expect others to abide by my measures. Similarly, I can't expect my neighbors to eat healthy, drive safely, drink responsibly, or even get a flu shot. In a free society, we are free to engage in a multitude of life-threatening behaviors. We are even free to kill ourselves; there is no law against drug overdose or even suicide!
With freedom comes the duty of personal responsibility. I am responsible for the health, safety, and well being of my family and no others. People have always had differing ideas for risk and reward balancing. That will never change. Look after yourself and your family and...
Stay the course.
Tom
 
 
 
 
 

June,
I've had no experience with chemo-based therapies so I can't give any information regarding that aspect of your post.  But I wanted to say that I'm sorry to hear about progression, and happy to hear that the Gamma Knife procedure went well.  I'll be watching your updates and you'll also be in my prayers.
Lou

Hi all. I just wanted to give an update on my situation and maybe get some advice about new treatment options.
One week ago Thursday I had Gamma Knife radio surgery on 5 brain mets that were discovered in a recent MRI. I had no symptoms at all – this was just the annual MRI that my oncologist likes to order for lung cancer patients. I’m really glad he did, as one of the tumors was already 1.9 centimeters! Most of the rest were quite small, but I was still very freaked out to learn I had 5 brain lesions all at the same time. Seems the horse is truly out of the barn at this point, so to speak!
I must say I was pleasantly surprised by how easy the whole Gamma Knife procedure was.  I slept through a lot of it, so my memories are somewhat foggy. Recovery was very easy & so far I have had no side effects. The pin sites where the frame was attached to my head were sore & slightly bruised for a few days, but this was very minor. I have been warned it is possible to have side effects a few months later as the tumors die, so I will be on the lookout for any odd neurological symptoms for a while. I will now have an MRI every 3 months in case new mets develop. From what I understand they can continue to zap them whenever any new ones appear. It does not seem to matter how often. Surely there is some limit, but for now they were very reassuring about it. I just wish my lung tumors could be treated this easily! I hope this will be helpful to anyone who has to undergo Gamma Knife surgery in the future.
My oncologist was planning to start me on Taxotere and Cyramza (also called Docetaxel & Ramucirumab) which is the standard treatment for progression after Opdivo & platinum based chemo, etc. But after checking with the clinical trials doc at Emory, both she and my doc agreed I should meet with them next week to go over all trial possibilities. At the minimum, there is a trial for Taxotere/Cyramza/Keytruda with seems to improve survival by at least a few months over the standard treatment. I know that sounds minimal but I figure even a few months helps as there is always a chance for a new breakthrough to come along at any time! Logically it seems like the Keytruda would be a waste of time since the other immunotherapy has already failed. But apparently there is some evidence that the Taxo/Cyramza’s action on the tumors can sort of jump-start the immune system and help the Keytruda to start working again. There is also a trial for TIL Therapy, but apparently it is a good bit more risky. That might be something we save for later if this doesn’t work. Apparently a small percentage of people do great on it, but a good number get worse because it wears you down so badly. I should learn more about all of this next week.
I’m told the side effects for Taxotere & Cyramza are worse than the Carboplatin & Alimta I had last year. Has anyone here been on this combo? If so, would you mind sharing your experience? I know everyone reacts differently and there are no guarantees. But I still find it helpful to hear other people’s stories. Our son is getting married on November 12th. I was so looking forward to it. Now I worry I will be too sick from chemo to attend. Not a huge deal in the grand scheme of things as I can attend virtually, but it's one more thing to make me sad. 
I’m praying we can make a good decision regarding what treatments to pursue. I appreciate any good thoughts or prayers or whatever you are comfortable with in the coming weeks!
Best to all - June

Good news! My mum's oncologist rang today as she's extremely busy tomorrow and everything is fine. No changes and next scan in 6 months. I'm so relieved. I can also start my new job tomorrow with a peace of mind. 

Wonderful news!  You brought a smile to my face.  I pray for many more such scans..
Lou

I’m so glad for you and your mom. Now, go knock your first days at that new job out of the park! 

A week is usual in the UK. Like Rikke says there aren't enough radiologists. They've always been quick with my mum luckily and fortunately she's never had treatment or scans delayed. I'm also extremely lucky she's under one of the best if not the best hospitals specializing in cancer in the country.

@Lmodge --  When I read your post, I considered whether to take it down. Our Forum is a safe space for lung cancer survivors and those who care for them. Obviously, we disallow all commercial enterprises advertising this and that. We also frown on people using our survivors and caregivers as survey fodder. Your post sneaked into the allowed category because you didn't link to a particular study or cite an email or contact method.
But Karen and RJN's critiques highlight my concern. Journalism today unfortunately arrives with a pre-established bias. Yours is a time certain for treating with immunotherapy. Our collective response is there is no time certain for starting or completing any specific therapy. There are guidelines and therapy decisions are best left to patients and their doctors period, full stop. We have too many on the sidelines trying to dictate what treatments we should have and for how long. We certainly don't want to give ammunition to insurance or government bureaucrats that affect OUR lives!
My disease has largely been ignored by society for almost 20 years of survivorship tenure. Now lung cancer has become a "thing" because most immunotherapy research started on lung cancer. It is the only form of therapy that is effective against all types of lung cancer (small cell, large cell, non small cell). We'd like to keep it that way.
Stay the course.
Tom