In this month of gratitude, we have asked many people to share themselves with GRACE and our community. We usually do the asking -- but Carlea asked me this time to share my thoughts of gratitude. Sometimes writing these things is a struggle.

Guest post by Dr. Cathy Pietanza, a board-certified medical oncologist at Memorial Sloan Kettering Cancer Center in New York. She specializes in cancers that arise in the lungs and cares for a large number of patients with small cell lung cancer (SCLC).

Drs. Leora Horn, Ben Solomon, & Jack West consider the merits of administering immune checkpoint inhibitors concurrently with standard first line chemotherapy or targeted therapy vs. sequential treatment.

Dr. Jack West asks the question of whether newer, more active ALK inhibitors such as alectinib should be used as first line therapy rather than for acquired resistance, including introducing the ALEX trial that is trying to answer this question.

Drs. Ben Solomon, Leora Horn, & Jack West consider whether immunotherapy might prove to be more problematic when given to a broader population of older and frail patients with advanced lung cancer.

Drs. Leora Horn, Ben Solomon, & Jack West review the potential rationale and possible limitations of combining different immuntherapy strategies with one another.

Dr. Jack West introduces the question of whether third generation EGFR tyrosine kinase inhibitors osimertinib and rociletinib should be used as first line therapy rather than for acquired resistance, including discussing key clinical trials on the topic.

Drs. Leora Horn, Ben Solomon, & Jack West assess whether clinical factors such as being a never-smoker or having a driver mutation (EGFR, ALK, etc.) reliably predict minimal benefit from immunotherapy agents.

Dr. Eddie Garon, UCLA, reviews the controversial question of whether PD-L1 expression is a reliable enough biomarker to be used to select patients to receive or not receive immune checkpoint inhibitor therapy in lung cancer.

Drs. Leora Horn, Ben Solomon, & Jack West consider the factors that might lead us to favor testing for PD-L1 at initial workup of a patient with advanced NSCLC or after progression.