case_images: PMC9747940_01
case_images: (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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case_images: PMC9747940_01_fimmu-13-1059331-g001.jpg
case_images: f1
case_images: 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 ).
case_images: (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).
case_images: fimmu-13-1059331-g002.jpg
case_images: PMC9747940_01_fimmu-13-1059331-g002.jpg
case_images: f2
case_images: 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.
case_images: 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).
case_images: fimmu-13-1059331-g003.jpg
case_images: PMC9747940_01_fimmu-13-1059331-g003.jpg
case_images: f3
case_images: 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 ).