case_images: PMC11783319_01
case_images: (A) Treatment timeline and representative imaging examinations. (B) Dynamic changes of CA19-9 with treatment. Note: K+L: pembrolizumab Lenvatinib; K+L+Flu+OX: pembrolizumab Lenvatinib+ fluorouracil+ oxaliplatin.
case_images: oyae340_fig1.jpg
case_images: PMC11783319_01_oyae340_fig1.jpg
case_images: F1
case_images: Enhanced computerized tomography (CT) showed a 5.0 x 4.7 cm hypodensity in the same location (Figure 1A). The patient's CA 19-9 level decreased to 91.41 U/mL after surgery (Figure 1B). Then, CA19-9 rose to 275 U/mL, and in April 2022, PET/CT revealed a 1.95 cm nodular hypodensity near the liver with increased SUVmax uptake of 13.97 (Figure 1A); local recurrence was evaluated. However, CA 19-9 rose to 1008.00 U/mL after the second surgery, and there was an abnormal signal in the liver on MRI (Figure 1A). A CT scan revealed progressive disease in the liver (Figure 1A), and the patient was treated with pembrolizumab 200 mg (on cycle 1 day 1), lenvatinib 8 mg orally once daily, and oxaliplatin 85mg/m2 and fluorouracil 500 mg every 3 weeks, for a total of 2 cycles,but the CA19-9 rose to 5785 U/mL, and an abdominal CT scan detected new lesions in bilateral anterior lobes of the liver, measuring right dominant lesion rose to 5.6 x 3.3 cm (Figure 1A and B). After 4 months of crizotinib therapy, the CA19-9 level downtrended from 5785U/mL to 28.45 U/mL (Figure 1B).
case_images: Integrative genomics viewer (IGV) image of RBPMS-MET fusion of this patient. (A) IGV image of MET part; (B) RBPMS part of IGV.
case_images: oyae340_fig2.jpg
case_images: PMC11783319_01_oyae340_fig2.jpg
case_images: F2
case_images: Patients with lung adenocarcinoma patients and ICC harboring EHBP1 or KIF5B or CAV1-MET fusions have achieved responses to crizotinib in previous case reports (Figure 2).