PMC9813774_01
Clinical course of the patient. CEA, carcinoembryonic antigen; DIC, disseminated intravascular coagulation; PS, performance status.
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Her platelet count rapidly decreased and her PS also reduced to 3 (Fig. 1). Two weeks after beginning sotorasib (960 mg/body), her platelet counts rose to the reference range and her PS improved from 3 to 1 (Fig. 1).
Enhanced chest and abdominal CT images (A) before and (B) after the administration of sotorasib. Enhanced head MRI (C) before and (D) after the administration of sotorasib. Yellow arrowheads point to multiple brain metastases. CT, computed tomography; MRI, magnetic resonance imaging.
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Two months after beginning sotorasib, the primary lung and multiple liver metastases had marked shrinkage (Fig. 2A and B) and the multiple brain metastases also disappeared (Fig. 2C and D).
(A) An abdominal contrast-enhanced CT image reveals a resistant lesion appearing in the liver with a yellow circle. Histopathologic analysis of biopsy specimen of the resistant lesion on the liver: (B) HE staining of the specimen, (C) strong positive TTF-1 nuclear staining, (D) with PD-L1 tumor proportion score of 0%, and (E) with scarce CD8-positive lymphocytes. CT, computed tomography; HE, hematoxylin and eosin; PD-L1, programmed death-ligand 1.
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Unfortunately, four months after sotorasib initiation, her carcinoembryonic antigen level had a tendency to rise again, and a new mass formation was observed in the liver (Fig. 3A and B). A biopsy of the same lesion revealed TTF-1-positive adenocarcinoma, which was diagnosed as metastatic recurrence of lung adenocarcinoma (Fig. 3C-E).