What kind of tests would be available for immuno therapies

Immunotherapy Testing Options for Josh's Situation

Based on Josh's clinical summary, several important tests could help guide immunotherapy decisions. Let me explain what's available and relevant to his relapsed/refractory follicular lymphoma:

Key Tests for Immunotherapy Planning

1. PD-L1 and PD-1 Expression Testing These tests measure proteins on cancer cells and immune cells that affect how well checkpoint inhibitor immunotherapies (like nivolumab or pembrolizumab) might work. According to NCCN Guidelines for B-Cell Lymphomas, PD-L1 status can help predict response to certain immunotherapies.

2. Tumor Microenvironment Analysis The document notes that "tissue from recent splenectomy is available for molecular testing." This tissue could be analyzed to understand:

• How many immune cells are present in the tumor
• What types of immune cells are there
• Whether the tumor is "hot" (immune-active) or "cold" (immune-suppressed)

3. BCL-6 and Related Pathway Testing Since Josh has BCL-6 pathway involvement (currently being targeted), additional testing could identify:

• Other mutations affecting immune response
• Epigenetic changes (like EZH2 mutations) that influence immunotherapy response

Important Context from Josh's Record

The document indicates Josh has already received:

• Mosunetuzumab (a bispecific antibody that engages immune cells)
• CAR-T therapy (Yescarta and IL-18 armored CAR-T)
• Rituximab (an immunotherapy antibody)

This extensive immunotherapy history is important because it may affect which additional immunotherapies could be effective.

Next Steps

According to ASCO Guidelines, the upcoming biopsy scheduled for [date removed] (mentioned in the document) would be an excellent opportunity to request comprehensive immunotherapy biomarker testing on the fresh tissue sample.

I'd recommend Josh discuss with his oncology team which specific immunotherapy tests would be most relevant given his previous treatments and current disease status.