How could I KNOW treatment would work?

1 year and 6 days ago I had my first PET/CT scan .  [I've mentioned that I led software development for the first generation of PET/CT systems - but this was my first image as a patient.]  That scan showed locoregional spread of my muscle invasive bladder cancer (MIBC) to nearby lymph nodes and changed the standard of care options - and the options would change again 35 days later with the FDA approval of enfortumab vedotin + pembrolizumab (EV/pembo - Padcev/Keytruda) as a first line option for locally advanced and metastatic MIBC.
The performance in the phase 3 clinical trial (EV 302) that lead to approval was impressive - overall response rate of 67.7% and complete response rate of 29.1%.  Testing was done looking at Nectin 4 expression (which enfortumab vedotin targets) and PD-L1 (which pembrolizmab targets) and both high and low groups showed had benefits in progression free and overall survival - therefore, no testing is required to begin EV/pembro treatment for locally advanced and metastatic MIBC.
As I was seeing a good response - I was still curous if there were any explanation (beyond the power of prayer and God's grace) as to why.  I requested a genetic analyis and received the report from a sample of my tumor resected 217 days earier.
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The report showed that I had a combined positive score (CPS) of 10 - which according to one study shows that I was likely to receive benefit from pembrolizumab. My tumor did not have FGFR mutations for which an FGFR inhibitor such as erdafitinib would be effective.
A Nectin-4 histology score (H-score) could evalute its expression in my tumor cells.  However, another study showed that a more common blood marker - C-reactive protein to albumin ratio (CAR) - can predict objective response to EV.

The results showed that lower CAR is associated with a better response.  I am familiar with C-reactive protein (CRP) from a previous health journey (see earlier in the blog) where I lost 100 lbs and reversed type 2 diabetes.  CRP is an indicator of inflammation - which is associated with type 2 diabetes.  It may be that maintaing my weight, exercising and maintaining a low carb real food diet (including healthy fats and proteins) has resulted in a CAR <1 and contributed to a good response to EV.  My lab work before each infusion includes an albumin measurement - I will ask to see if CRP can be measured as well to see if my CAR is below 1.