case_images: PMC10616458_01
case_images: (A) The thoracic CT image displaying lung lesions during initial evaluation. (B) The thoracic CT scan showing the changes in lung lesions after 2 months of gefitinib treatment. (C) The chest CT image during gefitinib resistance.
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case_images: CA72-4 was 11.78 U/ml, while no abnormalities were observed in the remaining indicators. Chest computed tomography (CT) revealed a 2.5 x 2.2 cm solid nodule in the middle lobe of the right lung, along with multiple small nodules in both lungs, a small amount of pleural fluid on the right side, and several enlarged mediastinal lymph nodes ( Figure 1A ). Two months after treatment, a thoracic CT scan indicated a significant reduction in the nodule in the middle lobe of the right lung, which had decreased to 1.5 x 1.0 cm, without enlargement of the hilar and mediastinal lymph nodes ( Figure 1B ). However, 9 months later, the patient again experienced chest pain and coughing up blood with dyspnea, serum carcinoembryonic antigen (CEA) was 91.22 ng/ml, and neuron-specific enolase (NSE) was 16.77 ng/ml, and CT imaging indicated partial pulmonary atelectasis and solid changes in the middle and lower lobes of the right lung, moderate pleural effusion on the right side, and an increase in bilateral lung lesions and regional lymph nodes ( Figure 1C ).
case_images: Flow-process diagram illustrating the patient's tumor management.
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case_images: Following the diagnosis of adenocarcinoma due to the EGFR mutation, the patient was prescribed the EGFR-TKI gefitinib at a dosage of 250 mg p.o. q.d ( Figure 2 ).
case_images: (A) The thoracic CT scan revealing the changes in lung nodules after 2 months of osimertinib treatment. (B) The chest CT image following termination of pregnancy. (C) Chest CT scan after 16 months of osimertinib treatment and demonstrating sustained partial response.
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case_images: The bilateral lung nodules were observed to have shrunk and decreased, the right pleural effusion disappeared, and the right hilar and mediastinal lymph nodes shrank, as confirmed by  Figure 3A . Therefore, 1 week after abortion, osimertinib targeted therapy was resumed, resulting in the disappearance of the pleural effusion and reduction in lung nodules and lymph nodes ( Figure 3B ). At the time of data collection, the patient had been on osimertinib treatment for over 16 months and was still benefiting from it ( Figure 3C ). Especially in the 20th month, after abortion at 9 weeks of pregnancy, serum levels of the above five tumor markers increased sharply, reflecting the critical situation caused by rapid tumor progression at that time; when continued treatment with osimertinib, the patient's serum tumor markers decreased rapidly, consistent with imaging findings ( Figure 3C ).
case_images: Serum HCG (A) and tumor markers CYFRA21-1 (B), CEA (C), CA125 (D), CA153 (E), and CA724 (F) levels during the entire diagnosis and treatment process.
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case_images: However, an unforeseeable emergency arose after the procedure: the human chorionic gonadotrophin (HCG) levels rapidly dropped ( Figure 4A ). Throughout the course of treatment, we also monitored the patient's serum tumor marker levels, the NSCLC-specific marker cytokeratin fragment 19 (CYFRA21-1) ( Figure 4B ), and the broad-spectrum markers CEA, CA125, CA153, and CA724 ( Figures 4C-F ).