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case_images: Tumor progression of the patient during the treatments. (A) The timeline of the therapies and imaging results of the computed tomography (CT) can during diagnosis and treatment at different time points. (B) The levels of secreted protein during treatment at different time points. (C) The site of EGFR mutation.
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case_images: An enhanced CT examination revealed suspicious malignant tumors in the left lung, left pleura, multiple lymph nodes (mediastinal, bilateral hilar, left clavicular area, hepatoduodenal ligament area, and retroperitoneum), as well as at the junction of the left and right lobes of the liver near the diaphragm apex and the right adrenal gland ( Figure 1A ). Additionally, the level of the serum tumor biomarkers CYFRA211, CEA, and CA724 were elevated above normal levels ( Figure 1B ). A liver biopsy performed on September 22, 2020, showed significant heterogeneity in tumor cells, indicating possible metastatic squamous cell carcinoma. Genetic testing of the liver metastasis tissue revealed EGFR p.G719C (mutation frequency 10.81%, number of supported reads 138;  Figure 1C ) and PIK3CA mutation. However, the CT scan conducted in November 2020 revealed an enlargement of the lung and liver lesions in comparison to the previous scan, leading to disease progression (PD) as per the Response Evaluation Criteria in Solid Tumors (RECIST) scoring criteria ( Figure 1A ). Additionally, the levels of tumor markers CYFRA211, CEA, and CA724 experienced further elevation ( Figure 1B ). By February 2021, the CT examination showed significant reduction in the size of the lesions in the left lung, liver, and adrenal gland, accompanied by a decrease in size in the mediastinal lymph nodes compared to the previous examination ( Figure 1A ). The levels of tumor marker levels also significantly decreased ( Figure 1B ).
case_images: The Immune microenvironment status of liver metastases. (A) Multicolor analysis is used to detect the phenotypes of different cell populations. (B, C) Perform cluster analysis on various cell types in the stroma and tumor regions.
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case_images: Additionally, a minimal number of exhausted T cells (CD8 + PD1 +) were observed in the tumor ( Figures 2A-C ).
case_images: Circulating tumor DNA change during ICI treatments. (A) The fish plot illustrates the frequency and types of gene mutations. (B) The level of ctDNA.CF1: 2020.11, CF2:2022.9. The symbol * represents translation termination of messenger RNA.
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case_images: B ). Blood plasma circulating tumor DNA (ctDNA)-NGS tests were performed simultaneously in November 2020 and September 2022, revealing a substantial decrease in the number and frequency of gene mutations (Fishplot) ( Figure 3A ). Moreover, quantitative analysis of ctDNA levels demonstrated a significant reduction (17.72 vs. 10353.37 HGE/ml), consistent with the radiological evaluation results ( Figure 3B ).