Would you use immunotherapy in a patient with metastatic lung adencoarcinoma, high PDL1, but had polymyositis as a presenting paraneoplastic syndrome?  

I personally would not start with a PD-1/L1 inhibitor in this population. Many trials with this class of immune checkpoint inhibitors allowed patients with autoimmune histories to be included if they had not required treatment for a prolonged period of time. Given the potential debilitating nature o...