case_images: PMC10830643_01
case_images: I (x-coordinate is the time, the unit is months): timeline diagram of the case receiving multiple lines of treatment; the PFS during this treatment period is expressed in length. II: Efficacy of treatment as demonstrated by chest CT and cranial MRI; (a) Primary lesions in the lungs (b) After treatment with ICIs, new lesions in the lungs and cranial metastatic lesions were observed (c) During treatment with T-DM1 (d) Disease progression after multiple lines pan-HER TKI therapy (e) Significant reduction in lung and brain lesions during treatment with re-challenge chemotherapy combination (f) Disease progression and multiple metastases in the brain (g) Radiotherapy was given for the cranial metastases, and subsequently in treatment with T-Dxd.
case_images: fonc-13-1268260-g001.jpg
case_images: PMC10830643_01_fonc-13-1268260-g001.jpg
case_images: f1
case_images: A 58-year-old male never-smoker was found to have an occupying lesion in the right hilar lung on chest computed tomography (CT) during a medical examination on 12.05.2019 ( Figure 1-IIa ). Strikingly, after two cycles, new frontal lobe and lung metastases were observed ( Figure 1-IIb ). Based on the HER2 mutation, he then received four anti-HER2 therapies, including ADCs (afatinib, T-DM1, pyrotinib, and poziotinib) for each relapse at recurrence ( Figures 1-IIc, d ). During this period, the patient underwent stereotactic radiotherapy (45 Gy/3 Gy/15 fractions) for significant enlargement of the intracranial metastasis ( Figure 1-IId ). After the second cycle, CT revealed a reduction in the size of the nodules in both lungs, with some lesions exhibiting cavity formation ( Figure 1-IIe ). On 16/05/2022, significantly enlarged primary foci and multiple brain metastases were observed ( Figure 1-IIf ). Interestingly, the patient responded to T-DXd even after heavy treatment and achieved PR ( Figure 1-IIg ), showing a significant improvement in PS (1-2).