case_images: PMC8495127_01
case_images: Timeline of disease status and corresponding treatment regimens.
case_images: fonc-11-731429-g001.jpg
case_images: PMC8495127_01_fonc-11-731429-g001.jpg
case_images: f1
case_images: From July 2017 to April 2018, pemetrexed was given 0.8 d1, q3w, for nine cycles, and the best response was stable disease (SD) ( Figure 1 ).
case_images: (A) Pathological biopsy on October 22, 2018. (B) Pathological biopsy on November 11, 2020. (C) Lung lesion progression and liver metastasis on October 13, 2020. (D) Lesion progression in March 2021 after osimertinib treatment.
case_images: fonc-11-731429-g002.jpg
case_images: PMC8495127_01_fonc-11-731429-g002.jpg
case_images: f2
case_images: ALK, and ROS1 were all wild types ( Figure 2A ). Liver metastasis occurred, and lung disease progressed on October 13, 2020 ( Figure 2C ). After discussion of the multidisciplinary team (MDT), pathological puncture and genetic testing were conducted again for the patient, and the results showed EGFR L858R and T790M mutations ( Figure 2B ). Then the patient was treated with osimertinib in view of EGFRT790M, but the follow-up CT until March 2021 showed that the lesion continued to progress ( Figure 2D ).
case_images: (A) Chest CT on October 25, 2018. (B) Chest CT on December 21, 2018. The response was partial response (PR).
case_images: fonc-11-731429-g003.jpg
case_images: PMC8495127_01_fonc-11-731429-g003.jpg
case_images: f3
case_images: Atezolizumab treatment was initiated on November 2, 2018, based on the results of the OAK clinical trial and the guidelines. After two cycles, CT showed partial response (PR) ( Figure 3 ).
case_images: (A) Programmed death-ligand 1 (PD-L1) tumor proportion score (TPS) <1%. (B) High infiltration of CD8+ tumor-infiltrating lymphocytes (TILs). (C) Presence of large numbers of CD4+ T cells in the stroma of the tumor. (D) Presence of large numbers of CD8+ T cells in the stroma of the tumor.
case_images: fonc-11-731429-g004.jpg
case_images: PMC8495127_01_fonc-11-731429-g004.jpg
case_images: f4
case_images: In addition, CD4+ and CD8+ T cells were highly infiltrated ( Figure 4 ).