case_images: PMC11335479_01
case_images: Case report timeline. aPD1, anti-Programmed cell Death 1; C, cycle; CP, carboplatin; CT, chemotherapy; CR, complete response, PD, progressive disease; PEM, pemetrexed; PR, partial response.
case_images: fimmu-15-1437961-g001.jpg
case_images: PMC11335479_01_fimmu-15-1437961-g001.jpg
case_images: f1
case_images: A 54-year-old smoker woman has been diagnosed with lung adenocarcinoma of the lower left lobe, discovered in the context of a chronic cough, with no metastatic spreading ( Supplementary Figure 1 ), in March 2022. She underwent a lower left lobectomy with lymph node dissection that allowed the removal of an invasive lung adenocarcinoma with negative margins and no involved lymph nodes (0+/7); the disease stage was IIIA (pT4N0M0). The patient then received adjuvant chemotherapy comprising four cycles of cisplatin and navelbin which ended in September 2022. She remained disease-free until December 2022, when a computed-tomography (CT) scan identified an asymptomatic metastatic relapse with the apparition of multiple nodular lesions in both lungs, with no spreading out of the lungs ( Figures 1 ,  2A-D ).
case_images: Thoracic CT scan imaging of the tumor response and immunohistochemistry analyses at different time points. (A) December 2022 at diagnosis of the metastatic disease with a metastatic spreading in both lungs. (B) March 2023 at the time of pseudoprogression after completion of 4 cycles of carboplatin-pemetrexed-pembrolizumab in the first-line setting of metastatic disease. (C) April 2023, four weeks after chemoimmunotherapy discontinuation, a thoracic CT scan was performed for radiotherapy preparation as part of the clinical trial in the second-line setting, in which the patient has been enrolled (NCT03431948). Lesions shrank spontaneously. (D) September 2023, six months after treatment discontinuation, a thoracic CT scan showed a prolonged complete response. (E) PD-L1 and CD8 staining on tumor biopsies at baseline (March 2022). (F) PD-L1 and CD8 staining on tumor biopsies at the time of pseudoprogression (March 2023).
case_images: fimmu-15-1437961-g002.jpg
case_images: PMC11335479_01_fimmu-15-1437961-g002.jpg
case_images: f2
case_images: She underwent a lower left lobectomy with lymph node dissection that allowed the removal of an invasive lung adenocarcinoma with negative margins and no involved lymph nodes (0+/7); the disease stage was IIIA (pT4N0M0). The patient then received adjuvant chemotherapy comprising four cycles of cisplatin and navelbin which ended in September 2022. She remained disease-free until December 2022, when a computed-tomography (CT) scan identified an asymptomatic metastatic relapse with the apparition of multiple nodular lesions in both lungs, with no spreading out of the lungs ( Figures 1 ,  2A-D ). Tumors, version 1.1), and non-target lesions associated with the apparition of new lesions in both lungs ( Figures 2A, B ;  Supplementary Table 2 ). The treatment was stopped, a progressive lesion was biopsied, and it confirmed the presence of the patient's lung adenocarcinoma. A complete response was later achieved and maintained while she was not undergoing treatment for 4 months ( Figures 2C, D ).