case_images: PMC6358372_01
case_images: Chest computed tomography (CT) in August 2007. Chest CT scan showing a nodule in the left lower lobe with left pleural effusion.
case_images: medi-98-e14100-g001.jpg
case_images: PMC6358372_01_medi-98-e14100-g001.jpg
case_images: F1
case_images: Enhanced chest-abdomen computed tomography revealed a tumor with a 3-cm diameter in the left lower lobe and left pleural effusion (Fig. 1).
case_images: Patient's treatment course. (A) Treatment course using cytotoxic chemotherapy. Chemotherapy with a combination of carboplatin (CBDCA) and docetaxel (DTX) was performed beginning in August 2007. The tumor and pleural effusion repeatedly decreased and increased in size. After each increase, 4 to 6 cycles of the same regimen were performed until 2013, for a total of 38 cycles over 6 years. Each arrow indicates one cycle. (B) Treatment course using epidermal growth factor receptor-tyrosine kinase inhibitors (EGFR-TKIs). Administration of erlotinib began in October 2013. Skin disorders interrupted its administration. The patient interrupted and resumed treatment repeatedly. Because of the detection of the T790 M mutation in exon 20 in malignant cells from the pleural effusion, erlotinib was changed to osimertinib in January 2017, and the administration of the latter is ongoing.
case_images: medi-98-e14100-g002.jpg
case_images: PMC6358372_01_medi-98-e14100-g002.jpg
case_images: F2
case_images: Tumors version 1.1, partial response was achieved, but he experienced progressive disease (PD) after 8 months. Six cycles of re-challenge chemotherapy (RC) using the same regimen were started in August 2008 and were effective. Thereafter, at each recurrence of PD, 4 to 6 cycles of RC were administered, and by 2013, 38 cycles had been completed over 6 years of treatment (Fig. 2A). For 3 years, 4-week erlotinib administration was repeated with 4-6-week treatment holiday intervals (Fig. 2B).