Yesterday, during my visit with my oncologist, I learned that the inquiry from Caris Molecular Intelligence a few weeks ago wasn’t entirely about “future treatments” if cancer were to recur. The genetic tests revealed that I have a “60% positive PD-L1,” which “might” suggest that I “might” be a candidate for an immunotherapy that could possibly help prevent a recurrence of my cancer. The immunotherapy would involve intravenous injection, every two weeks for a year, of a drug called Imfinzi (a brand name for durvalumab). There’s no assurance my insurance company would pay for it, the doctor says, because I don’t quite fit the profile of people for whom the drug is recommended: that is, people who cannot be treated for lung cancer with surgery. But, she said in effect, “it seems like the drug works for people who are otherwise like you, so it makes sense to try it.”
Once I got home, I did some research. PD-L1 is shorthand for Programmed death-ligand 1, not a particularly cheery name for a protein for which I am 60% positive. I’ll admit, the descriptions of the protein, as well as its functions, are more complex than I was willing to attempt to understand. But the mere fact that I might be a guinea pig outside the scope of a formal study was a bit off-putting. Oh, and there are potential side-effects to treatment with the drug aimed at addressing PD-L1:
- Lung problems (pneumonitis)
- Liver problems (hepatitis)
- Intestinal problems (colitis)
- Hormone gland problems (especially the thyroid, adrenals, pituitary, and pancreas)
- Kidney problems, including nephritis and kidney failure
- Skin problems
- Problems in other organs
- Severe infections
The PD-L1 protein disguises cancer cells from the immune system. According to the AstraZeneca Infimzi marketing site, the drug binds to and blocks the PD-L1 protein, thereby allowing the immune system to “see” and attack cancer cells. And, the site mentions, “There is a chance that IMFINZI may affect healthy cells, too.” Yeah. The side-effects.
Before I learned more details about the immunotherapy than the oncologist shared, I said I’d consider it if the insurance company would pay for it. Now that I know a bit more, I think I’ll pass. I’ll take my chances than my PD-L1 proteins might disguise future cancer cells from my immune system. I’m not beyond changing my mind, but for the moment, I think I’d rather minimize the chances of the kinds of side-effects this treatment might bring.
Just three more radiation treatments and two more chemo treatments. As of next Tuesday, I’ll only have one more treatment left: my final chemo. I am looking forward to the end of this process.