PMC9747940_01
(A) CT image at the time of initial diagnosis. (B) Image after first-line treatment. (C) Image after second-line treatment. (D) Image after third-line treatment. (E) Image after fourth-line treatment. (F) Image after fifth-line treatment. (G) Image after sixth-line treatment. (H) Image after seventh-line treatment. (I) Image after eighth-line treatment.
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However, the current chest computed tomography (CT) and positron emission tomography (PET)-CT suspected left-sided advanced central-type lung cancer with multiple lymph node metastases in the mediastinum and hilar and pleural effusion ( Figure 1 ).
(A) Change in neuron-specific enolase (NSE) (ng/ml) during the treatment period. (B) Change in pro-gastrin-releasing peptide (Pro-GRP) (pg/ml) during the treatment. (C) The microscopic image of the tumor: x200 (C1), x400 (C2).
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Figure 2A ) and pro-gastrin-releasing peptide (Pro-GRP) ( Figure 2B ) than the normal. Fortunately, the brain magnetic resonance imaging (MRI) showed no brain metastases. Then, she accepted the fiberoptic bronchoscopy and biopsy at the same time ( Figure 2C ). Notably, the levels of NSE ( Figure 2A ) and Pro-GRP ( Figure 2B ) were rising, and the ultrasonography and CT scan showed that the left clavicle lymph nodes were enlarged.
The treatment progress of the patient. The first stage includes the first to fourth lines of treatment; the fifth to eighth lines of treatment are the second stage. PR, partial response; PD, progressive disease; SD, stable disease. The efficacy evaluation was judged according to the Response Evaluation Criteria in Solid Tumours (RECIST) (Version 1.1).
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She was administered four-line systematic chemotherapies including etoposide and carboplatin (EC) ( Figure 3 ), vinorelbine and ifosfamide (NI) followed by anlotinib ( Figure 3 ), irinotecan and pobaplatin (IP) ( Figure 3 ), and albumin paclitaxel combined with cisplatin (TC) ( Figure 3 ). Then, she received the fifth-line treatment with albumin paclitaxel plus programmed cell death receptor-1 (PD-1) inhibitor toripalimab ( Figure 3 ). Afterward, she continued receiving toripalimab alone as the maintenance treatment ( Figure 3 ). Thus, she started the sixth-line treatment with etoposide plus carboplatin and tislelizumab ( Figure 3 ). From that time, she received the seventh-line gemcitabine plus tislelizumab ( Figure 3 ). Unfortunately, owing to the coronary heart disease and percutaneous coronary intervention, she delayed receiving the tislelizumab monotherapy then ( Figure 3 ). Fortunately, she benefited from the eighth-line anlotinib plus durvalumab therapy for up to 11 months ( Figure 3 ).