PMC7773813_01
The timeline showing the history of treatment and examinations for the patient under current study.
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A 45-year-old male underwent a left upper lobectomy and postoperative pathology revealed invasive stage IIIA lung adenocarcinoma ( Figure 1 ). TP53 p.Y220C (MAF: 37.0%), and RB1 single copy loss ( Figure 1 ). Four months later, he progressed with liver metastasis in left lobe ( Figure 1 ). TP53 p.Y220C (MAF: 0.5%) ( Figure 1 ). The TMB was calculated as 2.2 mutation/Mb. Encouragingly, both liver lesions showed significant regression ( Figure 1 ). However, the CEA level increased to 23.1 mg/ml at the 19th month after the initiation of Osimertinib treatment, and 2 months later, the patient progressed with enlarged mediastinal lymph nodes ( Figure 1 ) with the CEA level of 73.9 mg/ml. TP53 p.Y220C (MAF: 53.3%), and a new mutation of RELN p.G1774E (MAF: 45.4%) ( Figure 1 ). The estimated TMB increased to 3.4 mutation/Mb. On these bases, the fourth-line salvage therapy using Nivolumab was prescribed and the therapeutic efficacy was considerable, as evidenced by the decreased CEA, regressed mediastinal lymph nodes, reduced metastases in both left and right liver ( Figure 1 ).