case_images: PMC7318868_01
case_images: The histopathology and immunohistochemistry (IHC) of metastatic tumor tissues of this patient. (A) The H&E staining in the microscopic observation (100x). (B) Immunohistochemical staining for PD-L1 expression (400x) showed that the tumor cells were positive for PD-L1. (C) The positive control of the IHC of PD-L1 expression (200x). (D) The negative control of the IHC of PD-L1 expression (200x).
case_images: fimmu-11-01127-g0001.jpg
case_images: PMC7318868_01_fimmu-11-01127-g0001.jpg
case_images: F1
case_images: The immunohistochemistry (IHC) data of the tumor tissue of this patient indicated the positive expression of PD-L1 protein (30%), and the tumor proportion score (TPS) was 20% and combined positive score (CPS) was 30 (Figure 1).
case_images: Response evaluation during the clinical course. (A) Trends in the level of tumor markers, including CA 199, CA 125 (left Y-axis), and CEA (right Y-axis) corresponding to the treatment timeline. X-axis showing the date of the disease course. The loss of the first value of CA 199 was due to the out of range of detection. (B) Representative images of the CT scan showed that both primary and metastatic lesions were shrunk and decreased after two cycles of gemcitabine plus nab-paclitaxel combined with a PD-1 antibody (toripalimab). Red circles indicate the primary pancreatic lesions.
case_images: fimmu-11-01127-g0002.jpg
case_images: PMC7318868_01_fimmu-11-01127-g0002.jpg
case_images: F2
case_images: Tumors (RECIST) version 1.1 (Figure 2). Surprisingly, he did not suffer any serious side effects except mild nausea and loss of appetite (grade 1, CTCAE 3.0), which was self-cured at the interstitial period of therapy. The treatment continued and repeated CT scans after four cycles showed shrinkage of the primary lesion but an increase in the number of the liver metastases. However, the CA199 level plummeted from 8,015 to 553.7 U/ml after the first four cycles of treatment (Figure 2). PR is still ongoing at the time of this report (eight cycles after the initial of the combination therapy). Primary and metastatic lesions were significantly decreased or shrank to nearly invisible status as the last evaluation showed, and the level of CA 199 has maintained within the normal for a long period but a little increase at the last test (Figure 2).