case_images: PMC11078020_01
case_images: Patient's treatment history and medication details.
case_images: fonc-14-1395654-g001.jpg
case_images: PMC11078020_01_fonc-14-1395654-g001.jpg
case_images: f1
case_images: Supplementary Figure 1 ). Starting from 17th January 2017, the patient received four cycles of post-operative adjuvant chemotherapy using the PP regimen (Pemetrexed 500mg/m2 and cisplatin 75mg/m2 once every three weeks) (specific treatment process illustrated in  Figure 1 ), followed by regular outpatient follow-ups.
case_images: Changes in liver metastases on abdominal CT. (A) Images of liver metastases before monotherapy with crizotinib. (B) Images of the liver at the time of disease progression following treatment with TGRX-326. (C) Hepatic imaging of disease progression following use of 4 courses of chemotherapy combined with immunotherapy for SCLC.
case_images: fonc-14-1395654-g002.jpg
case_images: PMC11078020_01_fonc-14-1395654-g002.jpg
case_images: f2
case_images: On October 19, 2020, a follow-up chest CT revealed slightly increased multiple nodules in the mediastinum compared to previous findings ( Supplementary Figures 2A, B ). An upper abdominal MRI indicated hepatic metastases and enhanced lesions in the lumbar vertebrae, suggesting bone metastasis ( Supplementary Figure 2C ). Figure 2D ), we considered that the lumbar pain is induced by bone metastasis. From March to April of the same year, palliative radiotherapy was administered to the L4 metastatic lesion in the lumbar spine at a dose of 39Gy in 13 fractions, whole-brain radiotherapy at a dose of 30Gy in 15 fractions, and a local boost of 12Gy in 6 fractions. Subsequently, progressive disease (PD) was observed ( Figures 2A, B ), leading to the patient's withdrawal from the clinical trial. On 2023-09-06, follow-up chest and abdominal CT scans indicated increased lymph node metastasis in the mediastinum and multiple liver lesions compared to previous scans ( Figure 2C ).
case_images: The profile of NSE in serum.
case_images: fonc-14-1395654-g003.jpg
case_images: PMC11078020_01_fonc-14-1395654-g003.jpg
case_images: f3
case_images: Supplementary Figure 3 ). Since genetic testing revealed the presence of an ALK rearrangement, the patient received oral crizotinib at a dose of 250 mg twice daily after radiotherapy and achieved a PFS of 15 months. Patient revisited on 2023-05-22 and was found to have a high level of neural-specific enolase (NSE), a tumor marker, reaching 287.6 ng/mL ( Figure 3 ).
case_images: Hematoxylin and eosin (H&E) staining and immunohistochemical staining (IHC) staining of the liver biopsy specimen. (A) H&E staining of the liver biopsy specimen. (B-D) IHC staining confirmed positive for TTF-1, CgA and CD56. IHC staining confirms (E) AFP-negative and (F-H) CK, CK7 and CK19-positive. IHC staining confirmed (I) CD10 positivity, (J) Napsin A negativity, (K) GPC-3 positivity, and (L) GS positivity. IHC staining confirmed (M) HepPar-1 negativity, (N) HSP70 positivity, (O) Ki-67 positivity, and (P) P40 negativity.
case_images: fonc-14-1395654-g004.jpg
case_images: PMC11078020_01_fonc-14-1395654-g004.jpg
case_images: f4
case_images: Syn (+) ( Figure 4 ). Therefore, we transitioned the treatment protocol to target SCLC. Starting from 2023-05-29, as palliative first-line treatment following transformation of the pathological type, the patient received treatment with 100mg/m2 of etoposide on days 1-3, carboplatin injection (AUC of 5 mg/ml/min) on day 1, and 200mg of sintilimab on day 1, once every three weeks, for a total of 4 cycles.