case_images: PMC8688253_01
case_images: CT scan of the tumors before and after first-line treatment.
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case_images: A computed tomography (CT) scan suggested an increase in the size of metastatic lymph nodes and the extent of bone metastases compared to that before treatment (Figure 1). The immunohistochemistry of PD-L1 with 22C3 antibody showed a Combined Positive Score (CPS) with 0 (Supplementary Figure 1). Then, the patient accepted second-line chemotherapy of albumin paclitaxel combined with tegafur (S-1) for 6 cycles from March 15th to July 10th, 2019.
case_images: MRI of the shoulder joint and elvic showed newly formed bone metastases in the left humeral (A, B) and the right iliac (C).
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case_images: The CT scan suggested PD with newly formed bone metastases after maintenance chemotherapy with S-1 for only 2 months (Figure 2). The timeline of patient treatment and change of tumor markers was shown in Supplementary Figure 2.
case_images: New pleural effusion (A) and cancerous lymphangitis (B) with enlarged mediastinal (C, D), axillary (E) and supraclavicular (F) lymph nodes on pulmonary CT after third-line treatment. Enhanced MRI of the abdomen showed enlarged retroperitoneal lymph nodes (G, H).
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case_images: f3
case_images: The evaluation after three cycles of third line docetaxel showed enlarged lymph nodes in the neck and axilla with aggravated cough, which suggested PD (Figure 3).
case_images: Radiological imaging of the tumors before (A, C) and after (B, D) 1 cycle of PD-1 blockade. Pre-immunotherapy tumor site indicated by orange arrow. LN, lymph node.
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case_images: f4
case_images: The result showed reduced pleural fluid, shrunken mediastinal, neck, axillary and retroperitoneal lymph nodes and normal tumor markers, which were suggestive of partial response (PR) (Figure 4).