Under normal circumstances, the human immune system (police system) can identify and remove cancer cells (bad egg molecules), but the cunning cancer cells can muddle through various hidden ways, one of which is the PD-1 and PDL1 system. Although cancer cells have various superficial characteristics, such as their tattoos (genetic mutations), they also have a good citizen card (PDL1 protein), and they can always rely on this good citizen card to fool the body’s immune system (police), so PDL1 immunotherapy is to block the good citizen card of cancer cells, so as to mobilize the body’s own immune system (police) to kill the cancer cells. cancer cells. Second, which patients can benefit from immunotherapy Patients without EGFR mutation, ALK mutation or ROS1 mutation can benefit from immunotherapy, while patients with EGFR mutation, who apply immunotherapy directly, have poor effect. Therefore, gene mutation testing is routinely recommended before immunotherapy is carried out. Third, which unresectable lung cancers can get a chance of surgery through immunotherapy The most common one is lung squamous carcinoma caused by smoking. Patients with lung adenocarcinoma have a higher probability of gene mutations (EGFRALK, etc.) and have a chance of targeted therapy, while 90%-95% of patients with squamous carcinoma caused by smoking cannot receive targeted therapy. Cigarette smoking causes more genetic mutations in lung cancer and is more confusing. Gene sequencing has shown that lung cancer patients who smoke have more than 10 times the number of genetic mutations than non-smokers. Immunotherapy is used to kill cancer cells by activating the immune cells in the body. The more genetic mutations there are, the better the immune cells can recognize the tumor cells and the more effective they are at killing them. This is why immunotherapy works well for smoking-induced squamous lung cancer. In the past, these patients with mid- to late-stage squamous carcinoma, who had smoked for a long time, resulting in their own weaker constitution, combined with emphysema or interstitial pneumonia and low lung function, were either unable to undergo direct surgery for direct radical treatment or, for reasons of excessive resection and low lung function. Pre-existing chemotherapy and targeted therapy have limited efficacy. Currently, in some patients, chemotherapy combined with immunotherapy can significantly reduce the size of the lesion or even disappear, thus giving this group of patients the opportunity to undergo surgery. Fourth, what are the common immunotherapy drugs currently available? 1.Pabrolizumab (K drug, Koreda, Keytruda) 2.Navulizumab (trade name: Odivo, Opdivo, commonly known as O drugs) 3.Treplexumab (topical benefit) 4.Durvalumab (durvalumab) 5.Tirelizumab (trade name: Bazedan) 6.Atelelizumab 7.Karelizumab (Erika) 8.Sindilizumab Injections V. What are the side effects of immunotherapy? Immune pneumonia, immune thyroiditis, immune myocarditis, etc. There are also risks associated with immunotherapy, so it is best to have an assessment of the baseline immune level before immunotherapy. Of course benefits and risks go hand in hand, and every drug is a double-edged sword. VI. When should immunotherapy be used? Early application of immunotherapy is generally advocated because immunotherapy is to attack cancer cells by mobilizing the body’s own immunity. Early stage patients have better immunity, better physique, high overall immunity and strong attacking ability. In contrast, patients with advanced lung cancer, who have often undergone multiple treatments, are weak and the efficacy of immunotherapy is relatively poor. Therefore, if there is an opportunity, it is still recommended to apply immunotherapy at an early stage. VII. Why should immunotherapy drugs be used early? After the diagnosis of lung cancer, the first treatment is especially important to shorten the battle with cancer cells. Because immunotherapy generally also has to be combined with chemotherapy. If chemotherapy alone is used in early stage without applying immunotherapy, after 2-4 courses of chemotherapy, many patients have already experienced serious post-chemotherapy side effects or have been beaten down by chemotherapy but with poor efficacy, and cannot tolerate more subsequent chemotherapy combined with immunotherapy. Eight, since immunotherapy is so good, can we just use immunotherapy without surgery? There are many patients, after immunotherapy, even the cancer cells have completely disappeared, so is it unnecessary to have surgery? Lung cancer is a mixture of one type of cancer cells, among which there are different lung cancer subtypes. Some subtypes may be more sensitive to immunotherapy, and if treated, there is a possibility that the lung cancer that is not sensitive may replicate and expand more severely, thus leading to the recurrence of the disease. Therefore, for lesions that have obviously regressed after immunotherapy, we should also eliminate the root cause of lung cancer and completely remove it.