Guests/Speakers
Dr. Julie Brahmer, Johns Hopkins University Hospital
Dr. Brahmer is a global thought leader in the emerging field of immunotherapy. Her research and clinical practice focus on the development of new therapies, including immunotherapies, for the treatment and prevention of lung cancer and mesothelioma.
Colette Smith – Voices of Hope Speakers Bureau member
Colette Smith is a dynamic lung cancer survivor, patient advocate, and community health champion who transformed her 2015 Stage 1A adenocarcinoma diagnosis into a powerful platform for change. As a never-smoker diagnosed through persistent self-advocacy, Colette’s mission is to emphasize the importance of patient empowerment and early detection.
Understanding Your PD-L1 Score: A Key to Personalized Lung Cancer Treatment
If you’ve been recently diagnosed with non-small cell lung cancer (NSCLC), chances are you’ve already heard the term PD-L1—and you may be wondering what your score really means for your treatment. The PD-L1 score in lung cancer is one of the most important numbers your oncologist will use to decide whether immunotherapy is right for you. Patient host Colette Smith talks with Dr. Julie Brahmer of Johns Hopkins University Hospital about how to interpret your Tumor Proportion Score (TPS), what it signals about immunotherapy options, and the questions you should never leave a doctor’s appointment without asking.
What Is PD-L1?
PD-L1, or programmed death-ligand 1, is a protein expressed on cancer cells that acts like a “cloaking device”—sending a “do not shoot” signal to your immune system. When cancer cells use this cloak heavily, they can hide from your body’s natural defenses. Immunotherapy works by interrupting this checkpoint pathway, allowing your immune system to recognize and fight the cancer.
Learn more about how the PD-L1 “cloaking device” works.
Why PD-L1 Testing Matters at Diagnosis
Dr. Brahmer emphasizes that for most patients with NSCLC, PD-L1 levels should be tested regardless of stage. Pathologists examine the biopsy sample and assign a Tumor Proportion Score (TPS) from 0 to 100, reflecting the percentage of cancer cells expressing PD-L1.
“When we’re talking with a patient, particularly those patients with metastatic lung cancer where we really need a drug or drugs to control the cancer quickly, all that information is used to decide which treatments we should start with.” — Dr. Julie Brahmer
- PD-L1 High (50% or greater): Single-agent immunotherapy may be effective on its own, though chemotherapy can be added depending on symptoms and disease burden.
- PD-L1 Low (1%–49%): A combination of immunotherapy and chemotherapy is often recommended.
- PD-L1 Negative (Less than 1%): Doctors will look more closely at other biomarkers or combination treatments to find the right approach.
But PD-L1 isn’t the whole story. Comprehensive biomarker testing for mutations like EGFR, ALK, ROS1, KRAS, MET, and HER2 is equally critical, as targeted therapies may be a better first-line option than immunotherapy for some patients.
Should You Re-Biopsy?
For patients diagnosed years ago—like Colette, who is living with an EGFR Exon 20 insertion 11 years after her diagnosis—Dr. Brahmer recommends repeat biopsies when the cancer changes or progresses. PD-L1 levels and other biomarkers can shift over time, and newer testing (such as for HER2 and MET) may unlock treatment options that didn’t exist before.
“Back in the day, maybe even five years ago, we never did that… but now in 2026, we are repeating biopsies… based on what treatments we have coming or potentially even what clinical trials might be going on.” — Dr. Julie Brahmer
Understanding Immunotherapy Side Effects
Immunotherapy can trigger the immune system to attack normal cells, leading to side effects ranging from rash and itching to thyroid issues and diarrhea. Roughly 1 in 10 patients experience severe side effects requiring steroids and discontinuation of treatment. Some effects, like the need for lifelong thyroid hormone replacement, can be permanent. Still, Dr. Brahmer points out a unique benefit: even after stopping immunotherapy, the immune response can continue working for many patients.
When Immunotherapy May Not Be the Right Choice
Dr. Brahmer outlines situations where immunotherapy may not be recommended:
- Patients with strong driver mutations where targeted therapy works better
- Organ transplant recipients (risk of rejection)
- Patients with active autoimmune diseases like Crohn’s, ulcerative colitis, or rheumatoid arthritis
The Power of Asking About Clinical Trials
One of Dr. Brahmer’s most important messages: always ask about clinical trials. Trials exist at every stage of treatment—including for newly diagnosed patients—and represent the path forward for improving outcomes.
“That’s what clinical trials are for is how can we improve therapies or how can we better understand how or why or if they might work for patients.”
— Dr. Julie Brahmer
Key Questions to Ask Your Oncologist
- Has my staging been completed?
- What mutations or fusions does my cancer have?
- What is my PD-L1 score (TPS)?
- Is a clinical trial right for me?
- Should I have a repeat biopsy before changing treatment?
Take this list with you. Print LCFA’s Questions to Ask Your Care Team about PD-L1 guide to bring to your next appointment.
Hope on the Horizon
From new immunotherapy combinations to CAR T-cell therapy and cancer vaccines, research continues to expand what’s possible for lung cancer patients.
“We are very excited about all the treatments that we have now to treat cancer, get the cancer under control and for some patients to cure their cancer, but we can always improve things.”
— Dr. Julie Brahmer
As Colette reflects at the close of the conversation:
“We’ve spoken a lot about science and what I hear from all of this is hope. Hope and new treatment options that are on the horizon for lung cancer patients.”
— Colette Smith, Patient Host
Your PD-L1 status is not a grade or a stage—it’s a roadmap. Get the full picture and access patient-friendly resources – visit our Understanding PD-L1 page.
