PMC6802557_01
The images of enhanced CT of chest, whole abdomen, brain and nasopharyngeal, and the whole body bone scan at the first time point. (A1, A2, B1, B2) A bulky soft tissue mass in the left lower lobe with lobulated, burr sign. Furthermore, the left lung door and mediastinal lymph nodes showed enlargement. (C) A kind of circular low density shadow in the liver. (D-F) Some focal ischemia in the brain, deputy nose and hypertrophy of bilateral inferior turbinate, and no bone metastasis (July 26, 2018).
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There were no trachea bronchial stenosis and no pericardial or pleural effusion (Figures 1A1, A2, B1, and B2). The enhanced CT of the whole abdomen showed a kind of circular low density shadow of 4.1x3.6 cm in the liver (Figure 1C). The brain and nasopharyngeal enhanced CT and the whole body bone scan were roughly normal except some focal ischemia, deputy nose, and hypertrophy of bilateral inferior turbinate (Figures 1D-F).
The IHC staining of percutaneous lung biopsy with different antibodies. IHC staining demonstrated PCK (+), P40 (+), CK5/6 (+), EBER1/2-ISH (+), CK7 (-), TTF-1 (-), and PD-L1 (+, positive proportion about 80%). Original magnification, x400 in HE, x200 in others.
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There were no trachea bronchial stenosis and no pericardial or pleural effusion (Figures 1A1, A2, B1, and B2). TTF-1 (-), and PD-L1 (+, positive proportion about 80%, antibody SP142, ZSGB-BIO Company) (Figure 2). After two cycles, we evaluated the curative effect according to enhanced CT of the chest and whole abdomen, and we found the size of tumor became larger (Figures 3A1 and A2) and the lesions of liver became more broader than before (Figures 3B1-B4, evaluation result was SD (according to RECIST 1.1)).
The images of enhanced CT of chest and whole abdomen after two cycles of chemotherapy. (A1, A2) A bulky soft tissue mass in the left lower lobe, which was larger than before. (B1-B4) Multiple classes of circular low density shadows in the liver, and the lesions of liver had become broader than before (October 29, 2018).
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After two cycles, we evaluated the curative effect according to enhanced CT of the chest and whole abdomen, and we found the size of tumor became larger (Figures 3A1 and A2) and the lesions of liver became more broader than before (Figures 3B1-B4, evaluation result was SD (according to RECIST 1.1)).
The images of chest CT after four cycles of chemotherapy. (A1, A2) The mass became bigger than before (December 25, 2018). The arrow pointed to the mass, which was bigger than before.
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After two cycles, we evaluated the curative effect according to enhanced CT of the chest and whole abdomen, and we found the size of tumor became larger (Figures 3A1 and A2) and the lesions of liver became more broader than before (Figures 3B1-B4, evaluation result was SD (according to RECIST 1.1)). We evaluated again after four cycles of chemotherapy, and found the CT imaging demonstrated significant progression of disease (Figure 4, evaluation result was PD).
The images of chest and brain CT after two cycles of immunotherapy. (A1, A2) The mass the size of the mass has reduced significantly. (B) No metastasis in the brain (February 21, 2019). The arrow pointed to the mass, which reduced after 2 cycles of immunotherapy.
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A2, evaluation result was PR), and there was no metastasis in the brain (Figure 5B).
The images of enhanced CT of the chest and whole abdomen after five cycles of immunotherapy. (A1, A2) The size of the mass has reduced significantly. (B) No metastasis in the brain (May 5, 2019). The arrow pointed to the mass, which became more smaller after 5 cycles of immunotherapy.
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After five cycles of nivolumab, the size of the tumor and the lesions of the liver became even smaller (Figure 6, evaluation result was PR). At the same time, we performed the blood tests again and found that the values of CYFRA21-1 and NSE dramatically decreased compared to before, especially the CYFRA21-1 (Figure 7).
The curves of CYFRA21-1 and NSE during the treatment. The values of CYFRA21-1 and NSE dramatically decreased compared to before immunotherapy, especially the CYFRA21-1.
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After five cycles of nivolumab, the size of the tumor and the lesions of the liver became even smaller (Figure 6, evaluation result was PR). At the same time, we performed the blood tests again and found that the values of CYFRA21-1 and NSE dramatically decreased compared to before, especially the CYFRA21-1 (Figure 7).