PMC7876253_01
Pathologic findings and CT findings. (A) H&E stain demonstrated poorly differentiated carcinoma (x100). (B) Immunohistochemical stain showed a low positive PD-L1 expression of TPS 5-10% (x400). (C) Immunohistochemical stain indicated a low CD8(+) TIL density of 147.91 psc/mm2 (x400). (D) Pulmonary lesions progressed in CT chest after one cycle of chemotherapy. (E) Pulmonary lesions lessened after two cycles of chemo-immunotherapy. (F) Pulmonary lesions shrunk after four cycles of chemo-immunotherapy.
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Pathologic findings and CT findings were shown in  Figure 1 , while time line and therapeutic regime were displayed in  Figure 2 .
Time line and therapeutic regime. LCLC, large cell lung cancer; PR, partial response; PD, progressive disease; chemo, chemotherapy of pemetrexed (800 mg/kg, d1) plus lobaplatin (50 mg, d1) and endosta (30 mg/day, 7days); chemo-immu, chemo-immunotherapy of pembrolizumab (200 mg/kg, d1) combining paclitaxel (400 mg/kg, d1) plus cisplatin (120 mg/kg, d2); immu, immunotherapy monotherapy of pembrolizumab (200 mg/kg, d1). This patient was diagnosed as stage IV (cT4N3M1) LCLC for diseased lungs and multiple metastases or lymph node enlargements based on fiberoptic bronchoscopy and CT imaging, together with pathological findings showing poor differentiated large cell tumor. Due to no driver gene mutations, this patient was initiated with classical chemotherapy. After disease progression, he turned to chemo-immunotherapy regime for a positive PD-L1 expression (TPS 5-10%). Compared with the baseline findings of fiberoptic bronchoscopy and CT imaging, this advanced LCLC patient benefited from chemo-immunotherapy and the following maintenance immunotherapy monotherapy when rapidly progressed after classical chemotherapy till November 2020.
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Pathologic findings and CT findings were shown in  Figure 1 , while time line and therapeutic regime were displayed in  Figure 2 .