PMC9945779_01
CT scan examination of the primary tumor at the first time of diagnosis (A). PET/CT scan examination of the primary tumor after the first-line treatment (3 cycles of carboplatin 650mg (AUC5) plus paclitaxel 300 mg (175mg/m2) in combination with radiotherapy at the third cycle) (B).
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A computed tomography (CT) showed a primary tumor, measuring 25 x 31 mm in upper lobe of left lung, invading mediastinal tissue, surrounding the aorta (Fig. 1A). The patient's Positron Emission Tomography (PET)/CT scan showed a reduction in the size of the primary tumor (12 x 7 mm) (Fig. 1B) and the tumor marker values returned to normal in December 2019.
Disease progressed after one year of the first-line treatment: primary tumor (A), left supraclavicular lymph node (B).
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PET/CT scan showed that the primary tumor had a size of 28 x 29 mm (Fig. 2A), maximum Standardized uptake value (SUVmax) 11.2, adhesion to mediastinal pleura and aorta. Besides, there was an appearance of the left supraclavicular lymph node having a size of 9 x 6 mm (Fig. 2B) and a few small nodes in the left hilum having a size under 10 mm.
Primary tumor before and after combination treatment. The primary tumor progressed after the second-line treatment (4 cycles of alimta, carboplatin, keytruda) (A). The primary tumor decreased at the end of treatment in combination with autologous NK cell therapy, gemcitabine, bevacizumab (B), after 3 months (C), after 6 months (D).
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PET/CT scan in September 2020. Primary tumor witnessed an increase to 26 x 35 mm (SUVmax: 22.6) (Fig. 3A). The PET/CT scan performed in March 2021 and September 2021 showed that the size of the primary tumor (Fig. 3B, 3D) decreased significantly compared to pre-treatment with combination therapy.
Immunophenotypes monitoring for NK cell treatments. The patient received cell treatments starting from October 2020. The patient received 6 treatment courses (1 infusion per treatment course) of NK cell treatments for 4.5 months. An infusion was performed every 3 weeks for 6 infusions.
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The patient received 6 infusion courses of autologous NK cell mass within 4.5 months, once every 3 weeks (Fig. 4).
Evaluation of the patient's quality of life before and after treatment. A. The quality of life: The patient's general was better and symptoms decreased dramatically. B. Functional symptoms: pain and cough of the patient went down significantly after 6 infusions.
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Outcomes after combination treatment for 4.5 months: The symptoms of dry cough and chest pain were gone while the patient was eating better, and the patient's quality of life was significantly improved (Fig. 5).
Blood biochemical examination. Most of biochemical markers: CEA, AST, Creatinin maintained at normal lever before and after NK cell treatments. Read blood cells, white blood cells, and platelet were a bit lower than normal at some times during treatment. A. CEA, B. AST, C. Creatinine, D. Red blood cells, E. White blood cells, F. Platelet.
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No significant side effects were observed during the use of combination therapy, and liver and kidney function assessments were within normal limits (Fig. 6).