Lung Cancer Treatment Complicated by Atezolizumab-Related Pneumonitis

Patient Info: Anonymized, Male, 70+

Biomarkers: EGFR mutation not detected; BRAF mutation not detected; ALK rearrangement not detected

The cancer progressed after chemoradiation. Atezolizumab was stopped because of pneumonitis, and he later began pemetrexed after a right adrenal mass became highly suspicious for malignancy.

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A Rare Airway Lung Cancer in a 31-Year-Old Woman

Patient Info: Anonymized, Female, Under 40 | Stage I

A 31-year-old non-smoker had a rare high-grade lung tumor that obstructed a bronchus after 2 years of cough, wheezing, and breathlessness.

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Durable brain and leptomeningeal response to pembrolizumab in Stage IV lung cancer

Patient Info: Anonymized, Female, 70+ | Stage IV

Biomarkers: PD-L1 high positive; EGFR negative; BRAF negative; KRAS negative; ROS1 negative; ALK negative

Metastatic Site: right adrenal gland, left sixth rib, brain,…

After 29 pembrolizumab cycles over 20 months, imaging showed no leptomeningeal disease, resolution of 3 brain lesions and marked reduction of the dominant frontal lesion; she remained neurologically intact and radiographically stable.

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Stage IV Small Cell Lung Cancer Causing Severe Cushing Syndrome

Patient Info: Anonymized, Male, 40s | Stage IV

Biomarkers: Ectopic ACTH secretion with markedly elevated ACTH and cortisol

Metastatic Site: liver|bones

The cancer and hormone syndrome progressed after an initial response, and he died after cardiopulmonary arrest 1 year after diagnosis.

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Small cell lung cancer presenting with spontaneous tumor lysis syndrome

Patient Info: Anonymized, Male | Stage IV

Metastatic Site: liver

He developed rapidly worsening encephalopathy, gastrointestinal bleeding, cyanosis and mottling and died before planned chemotherapy could be started.

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Autoimmune hemolytic anemia after 39 cycles of nivolumab for metastatic lung cancer

Patient Info: Anonymized, Male, 70+ | Stage IV

Metastatic Site: liver, bone

While nivolumab remained on hold, his lung cancer was stable on imaging and clinically, and hemoglobin had recovered to 14.6 g/dL about 4 months after high-dose prednisone and rituximab began.

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Small cell lung cancer found after severe digestive and neurologic symptoms

Patient Info: Anonymized, Male, 50s

Biomarkers: ANNA-1 positive at 1:61, 440; neuronal acetylcholine receptor antibody 0.05 nmol/L

His speech and strength improved with treatment, and PET/CT 4 months after the initial assessment showed no recurrent or metastatic lung cancer.

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ERBB2-Mutated Metastatic Lung Adenocarcinoma With Leptomeningeal Progression

Patient Info: Anonymized, male

Biomarkers: ERBB2 A775_G776 insYVMA mutation with amplification

The final treatment produced a mixed systemic response, but leptomeningeal disease developed.

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ERBB2-Mutated Metastatic Lung Adenocarcinoma With Treatment Intolerance and Progression

Patient Info: Anonymized, male

Biomarkers: ERBB2 A775_G776 insYVMA mutation

After poorly tolerated earlier regimens with stable disease, he developed symptomatic progression during 1 month of afatinib.

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ERBB2-Mutated Metastatic Lung Adenocarcinoma Progressing Through Multiple Therapies

Patient Info: Anonymized, female

Biomarkers: ERBB2 mutation

The cancer progressed during afatinib, nivolumab and a later paclitaxel rechallenge.

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ERBB2-Mutated Metastatic Lung Adenocarcinoma With Progression Across Multiple Regimens

Patient Info: Anonymized, male

Biomarkers: ERBB2 V777delinsVGSP mutation

After a brief period of stable disease on cisplatin plus docetaxel, the cancer progressed through erlotinib, gemcitabine and afatinib.

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ERBB2-Mutated Stage III Lung Cancer With Liver Recurrence and Multiple Lines of Therapy

Patient Info: Anonymized, female, 60s | Stage IV

Biomarkers: ERBB2 exon 20 insertion

Metastatic Site: liver

After 6 months of disease control on vinorelbine plus trastuzumab, the cancer progressed in all sites and she chose hospice care.

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Stage IV ERBB2-Mutated Lung Adenocarcinoma Responding to HER2-Targeted Therapy

Patient Info: Anonymized, female, 60s | Stage IV

Biomarkers: ERBB2 exon 20 insertion

Metastatic Site: bilateral lungs

Afatinib showed a response after 1 month, but insurance denial required a return to trastuzumab-based treatment.

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Stage IV ERBB2-Mutated Lung Cancer With Extensive Bone Metastases

Patient Info: Anonymized, female, 60s | Stage IV

Biomarkers: ERBB2 exon 20 insertion. A PIK3CA mutation was later detected at progression and considered a possible resistance mechanism.

Metastatic Site: bone

After progression on pemetrexed following several earlier treatment lines, she transitioned to hospice care.

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Stage IV ERBB2-Mutated Lung Adenocarcinoma With Brain Metastases and Multiple Targeted Therapies

Patient Info: Anonymized, female, Under 40 | Stage IV

Biomarkers: ERBB2 exon 20 insertion, exact sequence not specified. ERBB2 copy-number gain was identified during progression on afatinib.

Metastatic Site: brain, adrenal gland, liver

The final documented afatinib plus bevacizumab rechallenge produced a mixed response followed by liver progression after 3 months.

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Lung Cancer Immunotherapy Caused New Type 1 Diabetes

Patient Info: Anonymized, Male, 70+ | Stage IV

Biomarkers: No ALK, ROS1, KRAS or EGFR alteration was detected; CK7-positive; TTF-1-negative; PAX-negative; CK20-negative

Metastatic Site: Pleura

After 4 combination-treatment cycles, the right-lung nodules had decreased markedly and nearly resolved. He continued maintenance pembrolizumab every 3 weeks and remained on insulin with stable glucose control.

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Lung Cancer Presenting With Tongue and Gastrointestinal Metastases

Patient Info: Anonymized, male, 40s

The cancer progressed after 2 cycles of carboplatin and pemetrexed, with worsening performance status, and chemotherapy was stopped.

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Lung Adenocarcinoma Metastatic to the Breast With Inflammatory Breast-Like Symptoms

Patient Info: Anonymized, female, 60s | Stage IV

Biomarkers: EGFR positive. Breast metastasis: TTF-1 positive

Metastatic Site: right breast

A PET scan after breast radiation showed no metabolically active cancer, but she died 2 months after the breast metastasis was diagnosed.

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Stage IIIB lung adenocarcinoma with separate papillary renal cell carcinoma: doing well more than 6 years after revised diagnosis

Patient Info: Anonymized, Female, 40s | Stage III

Biomarkers: Lung tumor: TTF-1-positive; PET-avid. Kidney lesion: PET-negative; later papillary renal cell carcinoma. No lung molecular biomarkers reported.

As of February 2014, she was doing well more than 6 years after the initial diagnosis, after the diagnosis was revised from presumed Stage IV lung cancer to Stage IIIB lung adenocarcinoma plus a separate papillary renal cell carcinoma.

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EGFR L858R-mutant Stage IV lung adenocarcinoma managed after gefitinib-induced lung injury

Patient Info: Anonymized, Male, 40s | Stage IV

Biomarkers: EGFR L858R mutation

Metastatic Site: liver, bone, hilar lymph nodes, mediastinal lymph…

Gefitinib produced early tumor shrinkage but was stopped for interstitial lung disease; subsequent carboplatin, pemetrexed, and bevacizumab produced a good response, while variceal bleeding was controlled with endoscopic treatment.

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Stage IV EBV-positive lymphoepithelioma-like lung cancer with brain metastasis

Patient Info: Anonymized, Female, 50s | Stage IV

Biomarkers: EBV-positive by in-situ hybridization

Metastatic Site: brain, retroperitoneal/posterior mediastinal soft…

Remained well and disease-free 6 months after resection of the retroperitoneal/posterior mediastinal metastasis and 8 years after initial presentation.

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Stage IV lung squamous cell carcinoma with liver metastasis treated with chemotherapy and 90Y radioembolization

Patient Info: Anonymized, Female, 50s | Stage IV

Metastatic Site: liver

After treatment for liver metastasis, PET CT 2 months after 90Y radioembolization showed complete tumor response without residual tumor, and she was alive without active disease.

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Stage IV large-cell lung cancer with adrenal metastasis: no recurrence after R0 surgery

Patient Info: Anonymized, Male, 60s | Stage IV

Biomarkers: Marker profile supported large-cell lung carcinoma: CK7/CEA/Ber-EP4 positive, with neuroendocrine and prostate markers negative.

Metastatic Site: left adrenal gland

Six months after combined lung and adrenal surgery with R0 resection, he had no evidence of recurrence.

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Stage IV lung adenocarcinoma with brain metastasis: partial remission after pemetrexed/cisplatin and AOSD-like paraneoplastic syndrome

Patient Info: Anonymized, Male, 50s | Stage IV

Biomarkers: No tumor molecular biomarkers reported. AOSD-like syndrome had high ferritin, inflammation markers, and RF/ANA negative.

Metastatic Site: brain

As of November 2011, pemetrexed/cisplatin produced partial remission of Stage IV lung adenocarcinoma and controlled the AOSD-like paraneoplastic syndrome without recurrent fever, rash, or arthralgia.

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