case_images: PMC11211453_01
case_images: (A) Liver metastases prior to treatment, a CT scan showed multiple slightly hypodense nodules in the hepatic parenchyma with blurred margins and uneven mild enhancement, the largest of which was about 1.2 cm. (B) CT revealed increased and enlarged liver metastasis despite two cycles of chemotherapy, the largest one was about 4.8 cm*4.1 cm. (C) CT showed that the liver metastases were slightly smaller than before after treatment with disitamabvedotin in combination with camrelizumab. The red arrows on the image illustrate the changes in liver metastases that were observed both before and during treatment.
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case_images: PMC11211453_01_fphar-15-1361628-g001.jpg
case_images: F1
case_images: In September 2021, a follow-up abdominal CT showed multiple slightly hypodense nodules in the hepatic parenchyma, with blurred margins and uneven mild enhancement, the largest being approximately 1.2 cm (Figure 1A). Criteria in Solid Tumors version 1.1 (RECIST 1.1) (Figure 1B). Considering the ERBB2 amplification of the tumor and the lack of a standard treatment for refractory PB, a second-line treatment of During 7 months of second-line treatment, CT scans were performed every 2 months and evaluated as stable disease (SD) based on RECIST 1.1 (Figure 1C).
case_images: (A) Hematoxylin-eosin staining showed a map-like tumor (magnification 40x). (B) Tumor cells were arranged in an organoid pattern around small lumens with mildly heterogeneous nuclei and granular eosinophilic cytoplasm (magnification x400). (C) Immunohistochemistry showed a positive nuclear and cytoplasm marker for beta-catenin (magnification x400); (D) Immunohistochemistry showed a partially positive marker for CK (pan) (magnification x400).
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case_images: PMC11211453_01_fphar-15-1361628-g002.jpg
case_images: F2
case_images: The diagnosis was that there were metastases of PB to the liver (Figure 2).
case_images: (A) CT showed liver metastases before treatment with surufatinib. (B) Two months after taking surufatinib, CT showed that some of the liver lesions were reduced in size, with decreased enhancement and obvious liquefied necrosis. (C) After 7 months of surufatinib administration, CT showed liver metastases with clearer borders, reduced enhancement, and reduced extent than before. (D) After taking surufatinib for 11 months, CT revealed that some of the liver metastases were slightly enlarged and some were slightly reduced. (E) After surgical resection of liver metastases, the patient continued to take surufatinib, and 2 months later, CT showed that most of the hepatic metastases intensified significantly less than before, and the morphology became irregular, and there was still enhancement within some of the lesions. The red arrows on the image illustrate the changes in liver metastases that were observed both before and during treatment.
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case_images: PMC11211453_01_fphar-15-1361628-g003.jpg
case_images: F3
case_images: As the CT scan showed significant enhancement of liver lesions in the arterial phase, indicating a rich blood supply, the treatment was changed to a daily oral anti-angiogenic drug called surufatinib in August 2022 (Figure 3A). CT scans revealed that the liver metastases had shrunk by nearly 45% compared to pre-surufatinib measurements (Figures 3B, C). Consequently, the patient obtained a partial response (PR) based on RECIST 1.1, which was maintained from February 2023 to June 2023. In July 2023, the dose of surufatinib was increased to 200 mg daily due to slight enlargement of some liver metastases and reduction in others (Figure 3D). PB. Postoperative CT scans showed reduced enhancement in most liver metastases, although some lesions continued to enhance (Figure 3E).
case_images: Schematic diagram of the antitumor treatment process. The patient had surgery to remove the primary tumor caused by PB but developed liver metastasis. Chemotherapy was ineffective, so they received disitamabvedotin and camrelizumab, which were able to control the growth of metastasis, but slowly. Targeted therapy with surufatinib gradually reduced the size of the metastasis. After 11 months, the patient underwent surgery to remove the metastasis and continued taking surufatinib as post-surgery treatment.
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case_images: PMC11211453_01_fphar-15-1361628-g004.jpg
case_images: F4
case_images: Currently, the patient has been alive for 33 months since the diagnosis of PB (Figure 4).