PMC8456297_01
CT shows the changes of primary pancreatic lesion and metastases in the right axillary, mediastinum, and left adrenal gland with treatment. The arrows in each layer from top to bottom refer to the left axillary lymph node, mediastinal lymph node, pancreas and abdominal lymph nodes, and the right adrenal gland. (A) CT at the first evaluation of the patient. (B) CT evaluation of progressive disease (PD) after first-line irinotecan, oxaliplatin and capecitabine (XELOXIRI) treatment for 3 cycles. (C) CT evaluation of PD after second-line paclitaxel and gemcitabine treatment for 2 cycles. (D) third-line Crizotinib treatment One month later, the patient's tumor shrank significantly, and CT was evaluated as partial response (PR). (E) when the patient was initially found to have brain metastases, the extracranial lesions were still stable, and the patient continued to take Crizotinib. (F) On April 13, 2021, The extracranial lesions are stable and the patient has been receiving Alectinib since June 2020. (G) at the latest CT evaluation, the extracranial lesions are still stable.
fonc-11-724815-g001.jpg
PMC8456297_01_fonc-11-724815-g001.jpg
f1
Abdominal contrast-enhanced CT scan revealed a 10.0*4.3-cm mass on the pancreatic body and tail with blurred borders with bilateral adrenal multiple metastases and multiple swollen lymph nodes in the mediastinum, left axilla, abdominal cavity, retroperitoneum and mesentery (Figure 1A). However, after 3 cycles of treatment, CT performed on August 15, 2019 showed that the primary tumor and metastases enlarged significantly (Figure 1B). However, the symptoms of abdominal pain worsened and the tumors progressed significantly (CT scan on October 8, 2019, Figure 1C) and serum CA19-9 increased slightly to 449.90 u/ml. ARID1B (c.821_823delCCG, 5.34%) and KEAP1(c.425C>T, 8.40%). ALK fusion was further confirmed by Fluorescence in situ hybridization test (FISH) and immunohistochemistry (IHC) (Supplementary Figure 1 A H&E; B IHC; C FISH; D NGS). The patient's abdominal pain disappeared and CT showed the tumor shrank significantly after 1 month (Figure 1D). Interestingly, the extracranial lesions (Figure 1E) and serum CA19-9 remained durable responses. The brain metastases were progressing, but the extracranial lesions were still stable (Figure 1F). In the latest examination, brain lesions (Figure 2D) and other parts (Figure 1G) of the disease are stable, and the patient is currently being treated with alectinib.
Brain MRI shows the change in brain metastases with treatment. (A) Brain MRI when the brain metastases first appeared. (B) Brain MRI showed that the brain metastases were significantly reduced after applying alectinib for nearly 2 months. (C) On April 13, 2021, Brain MRI showed that the right cerebellum lesion increased in size. (D) On July 7, 2021, the most recent Brain MRI showed that the brain metastases were stable.
fonc-11-724815-g002.jpg
PMC8456297_01_fonc-11-724815-g002.jpg
f2
On June, 2020, the patient complained of headache, decreased vision in the left eye and disturbance of balance in the left limb, CT and MRI on June 22, 2020 showed a progression in brain metastasis (Figure 2A). The brain lesions shrank significantly (MRI scan on August 14, 2020, Figure 2B). However, after continuing the treatment for nearly 10 months, on April 13, 2021, the patient's reexamination of the brain MRI showed that the right cerebellum (Figure 2C) and left frontal lobe lesions increased in size. In the latest examination, brain lesions (Figure 2D) and other parts (Figure 1G) of the disease are stable, and the patient is currently being treated with alectinib.
(A) Treatment process. PFS, progression-free survival; XELOXIRI, irinotecan, oxaliplatin and capecitabine; PD, progressive disease; SD, stable disease; PR, partial response; mos, months. (B) Change in cancer antigen 19-9 (CA19-9) (U/ml) levels and carcinoembryonic antigen (CEA) (ng/ml) levels with treatment.
fonc-11-724815-g003.jpg
PMC8456297_01_fonc-11-724815-g003.jpg
f3
The patient's treatment process and changes in tumor markers are shown in Figures 3A, B, respectively.