PMC8368438_01
PET/CT revealed a right lower lobe mass and 4R/7 lymphadenopathy before treatment.
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In June 2018, a 69-year-old male with a 30 pack-year smoking history was referred to Shanghai Pulmonary Hospital for a right lower lobe mass and 4R/7 lymphadenopathy (Figure 1), along with severe chronic obstructive pulmonary disease (COPD).
Chest CT scans. (A) CT before immunotherapy. (B) CT revealed a partial response after four months of immunotherapy. (C) CT revealed disease progression after acquired resistance of immunotherapy. (D) CT revealed an abscopal effect after one month of local ablation.
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However, after four cycles the primary lung lesion was still not effectively controlled, and disease progression in the chest was confirmed by imaging (Figure 2A), and ECT bone scan revealed a new lesion in the right tibia, indicating the occurrence of bone metastases. August 2019, the patient participated in a single-arm phase II clinical study of camrelizumab plus apatinib for advanced NSCLC. After four cycles, a partial response (PR) was observed in December 2019 (Figure 2B), with a PFS of 12.8 months. Oligo-progression in the chest was found in August 2020, with enlarged primary lung lesion and mediastinal 4R/7 lymphadenopathy (Figure 2C). Surprisingly, the enlarged 4R/7 lymph nodes shrank significantly at the same time and continued to decrease by subsequent follow-up scans, indicating an abscopal effect of local ablation (Figure 2D).
Timeline of treatment administration from the episode of care.
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The timeline treatment administration from the episode of care was presented in Figure 3.