case_images: PMC11377275_01
case_images: Timeline in case presentation.
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case_images: f1
case_images: In the aftermath of the surgical intervention, an additional eight cycles of CAPEOX regimen were administered ( Figure 1 ).
case_images: MRI exam changes before (A, B) and after (C, D) ICI therapy.
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case_images: f2
case_images: Unfortunately, in August 2022, he was diagnosed with liver metastasis with abdominal MRI on routine physical examination, which unveiled a spectrum of intrahepatic complexities, including multiple metastatic lesions, intrahepatic bile duct dilation, metastasis to the porta hepatis lymph nodes, and a potential tumor thrombus in the left branch of the portal vein ( Figures 2A, B ). CA19-9 and CEA remained within normal limits ( Figure 3 ) and surveillance radiographic changes in May, 2024 showed no evidence of metastatic disease, indicating a remarkable response when compared to the MRI before the initiation of immunotherapy ( Figures 2C, D ).
case_images: CEA/CA19-9 level changes before and after ICI therapy.
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case_images: f3
case_images: Laboratory results showed an evidently increase of carbohydrate antigen 19-9 (CA19-9) and carcinoembryonic antigen (CEA) ( Figure 3 ), which were 17288U/ml (0-39) and 42.37ug/L (0-5), respectively. Only after 3 cycles of treatment of pembrolizumab, the laboratory results and clinical status of the patient improved tremendously ( Figure 3 ). CA19-9 and CEA remained within normal limits ( Figure 3 ) and surveillance radiographic changes in May, 2024 showed no evidence of metastatic disease, indicating a remarkable response when compared to the MRI before the initiation of immunotherapy ( Figures 2C, D ).