case_images: PMC11341367_01
case_images: Pelvic MRI images of iliac bone metastases (A) before radiotherapy in August 2020; (B) after radiotherapy in September 2020; (C) during the albumin-bound paclitaxel treatment in September 2021; and bone scan images (D) before radiotherapy in August 2020; (E) during the albumin-bound paclitaxel treatment in September 2021.
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case_images: Her magnetic resonance (MR) scanning images and bone scan image showed abnormal signals in the right sacrum, ilium and acetabulum, considering tumor metastasis ( Figures 1A, D ). And the tumor size was obviously reduced ( Figure 1B ). August 2020, the patient received albumin-bound paclitaxel for one year. According to the Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1, she experienced stable disease (SD) during this period ( Figures 1C, E ).
case_images: Chest CT images of lung metastases (A) before Almonertinib + Pyrotinib treatment in December 2022; during Almonertinib + Pyrotinib treatment (B) in March 2023; and (C) in November 2023.
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case_images: A chest CT scan revealed multiple nodules in both lungs, increased and partially enlarged lymph nodes in the right hilar and mediastinal lobes, which were considered metastatic tumors ( Figure 2A ). Two months later, the CT scan of the chest showed that the nodules in both lungs were significantly reduced ( Figure 2B ). As of the last review in November 2023, the patient's efficacy was evaluated as partial response according to the RECIST version 1.1 ( Figures 2C ,  3D ).
case_images: MRI images of brain metastases (A) before radiotherapy in December 2022; (B) after radiotherapy in January 2023; during Almonertinib + Pyrotinib treatment (C) in March 2023; and (D) in November 2023.
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case_images: MRI of the brain revealed strengthened nodules in the right temporal lobe and parietal cortex ( Figure 3A ). MRI showed the tumor size and number were obviously reduced ( Figure 3B ). The MRI revealed stabilization of the disease in the brain ( Figure 3C ). The main adverse event was grade II diarrhea (according to the common terminology criteria for adverse events of the National Cancer Institute of the United States, CTCAE 5.0). As of the last review in November 2023, the patient's efficacy was evaluated as partial response according to the RECIST version 1.1 ( Figures 2C ,  3D ).
case_images: Summary of the treatment timeline of this case.
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case_images: The timeline for treatments and efficacy evaluations in this case is summarized in  Figure 4 .