PMC10192877_01
(A) refers to the timeline of the patient. (B) shows a series of representative different section of chest CT image changes over time. Black thin arrows indicate primary tumor lesion in left upper lung. Black thick arrows indicate immune checkpoint inhibitors-associated pneumonia in bilateral lung. AP chemotherapy, pemetrexed plus carboplatin chemotherapy. irAEs, immune-related adverse events.
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F1
A chest computed tomography (CT) scan in April 2022 showed a mass in the lingual segment of the upper lobe of the left lung, with a cavity and mediastinal lymph node enlargement (Figure 1). After exclusion of a series of contraindications, the patient began combination therapy with AP chemotherapy (pemetrexed disodium; 500 mg/m2, day 1, every 3 weeks) plus carboplatin (AUC 5-6, day 1, every 3 weeks) and camrelizumab (anti-PD-1, 2 mg/kg, every 3 weeks) on 28 May 2022 (Figure 1A). When preparing for the fourth round of combined therapy on 16 August 2022, the chest CT scan suggested a large shrinkage of the primary tumor lesion, but additional interstitial abnormalities in the bilateral basal and subpleural lungs were observed (Figure 1B), along with respiratory distress. The combined treatment was discontinued, oxygen inhalation was initiated, and methylprednisolone (40 mg/day) was added (Figure 1A). After 1 month of corticosteroid treatment combined with nintedanib, the interstitial changes in the chest imaging findings of the patient improved (Figure 1B). During the next 4 months of follow-up, the clinical condition of the patient further improved, with stabilization of the interstitial abnormality and primary tumor lesion (Figure 1) and with significant reductions in serum CEA and KL-6 levels (Figure 2).
Changes in serum CEA and KL-6 levels through the clinical course. CEA, Carcinoma Embryonic Antigen, KL-6, Krebs von den Lungen-6.
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F2
The laboratory tests revealed no abnormalities in white blood cell count and C-reactive protein level, but a dramatic elevation of serum tumor markers (carcinoma embryonic antigen; CEA: 72.3 ng/mL [0-5 ng/mL] and Krebs von den Lungen-6; KL-6: 1454 U/mL [0-200 ng/mL]) was observed (Figure 2). During the next 4 months of follow-up, the clinical condition of the patient further improved, with stabilization of the interstitial abnormality and primary tumor lesion (Figure 1) and with significant reductions in serum CEA and KL-6 levels (Figure 2).