PMC9189884_01
Dynamic changes in the chest CT scan during treatment. (A) On 5 July 2019, chest CT revealed an irregular mass in the left lower lobe. (B) On 7 September 2019, chest CT indicated stable disease after 2 cycles of first-line therapy. (C) On 9 January 2020, chest CT revealed stable disease after 6 cycles of first-line therapy. (D) On 26 May 2020, chest CT showed that the primary lesion was larger than before and progressive disease occurred. (E) On 17 June 2020, after 1 cycle of second-line therapy, the primary lesion was still enlarged and diffuse ground glass of both lungs was increased. (F) On 27 August 2020, chest CT indicated stable disease 1 month after osimertinib plus anlotinib therapy. (G) On 19 May 2021, chest CT revealed stable disease 9 months after osimertinib plus anlotinib therapy. (H) On 14 November 2021, chest CT still showed stable disease 15 months after osimertinib plus anlotinib therapy.
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The curative effect was evaluated stable disease (SD) during treatment (Fig. 1B and C). However, the patient's cough and short of breath aggravated and the CT scan indicated enlarged primary lesion in May 2020 (Fig. 1 D). The chest CT scan indicated stable disease 1 month later (Fig. 1 F). As the recent follow up, chest CT indicated that the curative effect was still SD (Fig. 1G and H).
The 24-h holter demonstrating sinus arrest with a maximum RR interval of 3.63 seconds.
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After several days, his respiratory symptoms of cough, chest tightness aggravated and chest CT scan showed that the primary lesion was enlarged and diffuse ground glass of both lungs was increased than before (Fig. 2 E). Additionally, during treatment, the ECG (electrocardiograph) monitoring showed a slow heart rate between 36 and 45 seconds per minute at night, and the 24-h holter indicated sinus arrest (Fig. 2).
The fluctuation of serum tumor marker, CEA, during osimertinib plus anlotinib treatment.
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The tumor marker, CEA (carcinoembryonic antigen), dropped dramatically later (Fig. 3).