Pemetrexed for Lung Cancer: 112 Real Stories

Stage IVB SMARCA4-deficient NSCLC with brain metastasis: stable disease after surgery, radiation, chemotherapy, immunotherapy, and bevacizumab

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

Biomarkers: SMARCA4/BRG-1 loss with TP53 and other mutations; TMB high; PD-L1 <1%; MSI-H not detected.

Metastatic Site: brain

As of October 2025, the patient had stable disease, no brain recurrence, a controlled left lower-lobe lung lesion, and manageable treatment toxicity while continuing bevacizumab plus pemetrexed maintenance.

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Stage IV Lung Cancer: Tina's Patient Story

Patient Info: Tina Powell, Female | Stage IV

As of November 2025, Tina was living with Stage IV lung cancer after 27 chemotherapy rounds over 3 years and was receiving an antibody-drug conjugate in a clinical trial.

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Four EGFR-Mutated Lung Cancers That Changed Form After Osimertinib — Case 4

Patient Info: Anonymized, female, 70+

Biomarkers: EGFR exon 19 deletion; TP53 p.L201fs

She died 3 months after starting carboplatin and pemetrexed for the transformed cancer.

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Stage IVA lung adenocarcinoma: fatal hemoptysis from pulmonary artery pseudoaneurysm after chemoradiotherapy

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

Biomarkers: CEA 62 ng/mL; CA19-9 and neuron-specific enolase within normal limits; no molecular biomarkers reported

Metastatic Site: bone (11th thoracic vertebra)

The patient died from airway obstruction after massive hemoptysis caused by rupture of a pulmonary artery pseudoaneurysm that developed at the tumor-invaded pulmonary artery site after chemoradiotherapy.

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Stage IVB EGFR-mutated lung adenocarcinoma with brain metastases: complete response and pathologic complete response

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

Biomarkers: Lung adenocarcinoma with EGFR L858R, PD-L1 TPS 95%

Metastatic Site: brain

Brain metastases achieved complete response on imaging, and surgery after systemic therapy showed pathologic complete response, ypT0N0M0 with 0/13 lymph nodes involved.

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Stage IV lung adenocarcinoma with paraneoplastic nephrotic syndrome during pembrolizumab therapy

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

Biomarkers: PD-L1 tumor proportion score >50% by Roche SP263 assay; KRAS exon 3 mutation; NGS/FISH did not identify targets for first-line targeted therapy

Metastatic Site: brain, bone

Pembrolizumab produced partial response and improved nephrotic-syndrome parameters, but bone metastases progressed in September 2022 and the right upper-lobe target lesion progressed 2 months later, leading to carboplatin plus pemetrexed.

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Stage IIIA KRAS p.G12V lung adenocarcinoma: pathologic complete response after chemoimmunotherapy and surgery

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

Biomarkers: KRAS p.G12V mutation; PD-L1 0% tumor-cell staining; <1% tumor-associated inflammatory-cell staining; no EGFR, ALK, or ROS1 driver mutation reported

Pathology after lobectomy showed a pathologic complete response, and surveillance imaging 12 months later showed no evidence of disease recurrence.

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Stage IIIA lung adenocarcinoma complicated by severe atezolizumab-induced liver toxicity

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

Biomarkers: PD-L1 49%; case text describes triple-negative status without expanding the specific markers

The patient was discharged clinically stable but with guarded prognosis after atezolizumab-induced vanishing bile duct syndrome, requiring prednisone, mycophenolate mofetil, ursodeoxycholic acid, prophylaxis, and close oncology/internal medicine follow-up.

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Metastatic lung adenocarcinoma with brain and iliac bone response to chemoimmunotherapy

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

Biomarkers: PD-L1-negative; no EGFR, ALK, ROS1, RET, KRAS, BRAF, MET, HER2, or NTRK alteration detected; TP53 mutation found.

Metastatic Site: left iliac bone, brain

Brain metastases achieved complete remission without cranial irradiation, and lung, bone, and brain lesions remained stable at last follow-up, with PFS of 35 months and OS exceeding 40 months.

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Stage IV lung adenocarcinoma with Aspergillus-associated empyema: disease control after chemotherapy and antifungal therapy

Patient Info: Anonymized, Male | Stage IV

Biomarkers: Pathogenic NF1 mutation; CEA elevated in pleural fluid; Aspergillus fumigatus cultured from bronchoalveolar lavage fluid

Metastatic Site: pleural disease/effusion (M1a)

After 6 cycles of pemetrexed/cisplatin and 6 months of antifungal therapy for Aspergillus-associated empyema, 12-month follow-up showed disease stability without recurrence.

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Stage IVA lung cancer with small-cell and adenocarcinoma components: mixed response before infection halted treatment

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

Biomarkers: PD-L1 <1%

Metastatic Site: bone (C2, T10, sacral vertebrae); malignant pleural…

The lung cancer showed mixed responses, with right-lung small-cell progression after chemotherapy/immunotherapy and later treatment interruption because of severe lung infection and respiratory failure.

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Metastatic lung adenocarcinoma with HER2 V659E/amplification responding to trastuzumab deruxtecan

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

Biomarkers: Initial lung testing showed no EGFR/ALK/ROS1 and PD-L1 TPS 3%. Later biopsy found HER2 V659E plus HER2 amplification.

Metastatic Site: liver, bone, brain

As of September 2024, metastatic lung adenocarcinoma had a sustained partial response to trastuzumab deruxtecan after HER2 V659E mutation and HER2 amplification were identified.

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Stage IIIB non-squamous NSCLC on chemoimmunotherapy: alcohol-related hypertonic hyponatremia corrected during oncology follow-up

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

Biomarkers: Tumor biomarkers not reported. Severe hyponatremia workup showed high serum osmolality and ethanol level.

He remained under oncology follow-up for Stage IIIB non-squamous NSCLC while alcohol-related hypertonic hyponatremia improved after detoxification and alcohol cessation.

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ALK-rearranged Stage IVA lung adenocarcinoma: partial response to pembrolizumab as eighth-line treatment

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

Biomarkers: ALK strongly positive by IHC 3+; ALK rearrangement confirmed by FISH; PD-L1 expression 95% by 22C3 immunostaining; CEA 2.3 ng/mL at diagnosis

Metastatic Site: brain

Nine months after pembrolizumab was started as eighth-line therapy, he maintained a partial response after prior progression on multiple ALK inhibitors and chemotherapies.

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Stage IVA EGFR L858R lung adenocarcinoma with malignant effusions and thrombosis

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

Biomarkers: EGFR exon 21 L858R mutation; TTF-1 weak positive; Napsin A positive; p40 negative; Ki-67 about 10%

Metastatic Site: malignant pleural effusion; malignant pericardial…

As of May 2025, abdominal pain had resolved, splenic infarction had not progressed, thromboembolic events were regressing, no new thrombus formation was seen, and outpatient follow-up continued while he remained on cancer and anticoagulation management.

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Stage IV Lung Adenocarcinoma With KRAS Mutation Responding to Immunotherapy and Anti-Angiogenic Treatment

Patient Info: Anonymized, male | Stage IV

Biomarkers: KRAS mutation; MET amplification

Metastatic Site: pleura

By the December 2023 follow-up, the pleural effusion had disappeared, the primary lung tumor had not progressed, and he was described as symptom-free and in good health on maintenance treatment.

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Stage IV ALK Non-Small Cell Lung Cancer: Alisa's Patient Story

Patient Info: Alisa Secaida, Female, Under 40 | Stage IV

Biomarkers: ALK-positive / ALK-rearranged

Metastatic Site: Brain; lymph nodes

As of May 2025, after alectinib and lung surgery, pathology still showed active tumor and lymph-node cancer cells, and Alisa was receiving IMRT for remaining disease.

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Poorly Differentiated Lung Adenocarcinoma Recurring After Surgery and Chemotherapy

Patient Info: Anonymized, male, 60s

Biomarkers: No driver mutation identified initially; recurrent tumor PD-L1 >50%

The cancer recurred in June 2024 with a para-aortic mass and enlarged mediastinal and supraclavicular lymph nodes. Camrelizumab was started, but he could not tolerate it and declined further treatment.

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Poorly Differentiated Lung Adenocarcinoma Without Recurrence After Surgery and Chemotherapy

Patient Info: Anonymized, male, 60s

Biomarkers: No driver mutation identified; PD-L1 at least 1%

No signs of recurrence were observed through April 2025 after surgery and 4 cycles of adjuvant chemotherapy.

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NRG1-Fusion Lung Adenocarcinoma With a Partial Response to Afatinib

Patient Info: Anonymized, female, 50s

Biomarkers: CD74-NRG1 fusion

Afatinib produced a partial response lasting 24 weeks, with progression after 32 weeks on treatment. She died in April 2022.

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Metastatic lung adenocarcinoma: pembrolizumab response complicated by pulmonary arterial hypertension

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

Biomarkers: CK7-positive; TTF-1-positive; p40 focally positive; high tumor mutational burden; no targetable mutations identified

Metastatic Site: right axillary lymph node; right hilar lymph nodes;…

As of April 2025, the patient was tolerating single-agent pemetrexed without evidence of lung cancer progression, while pulmonary arterial hypertension symptoms had improved on riociguat and macitentan.

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Metastatic lung adenocarcinoma: complete remission on nivolumab complicated by immune-mediated diabetes

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

Biomarkers: Lung tumor: EGFR wild type, ALK rearrangement not detected. Immune-mediated diabetes: islet/GAD antibodies negative and C-peptide undetectable.

Metastatic Site: brain (cerebellum and occipital lobe); liver

As of March 2025, serial CT and MRI scans through October 2023 showed no evidence of oncologic disease after nivolumab, while immune-mediated diabetes was controlled with basal-bolus insulin.

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EGFR-Mutant Lung Adenocarcinoma That Transformed to Small Cell Lung Cancer

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

Biomarkers: EGFR exon 19 deletion

Metastatic Site: brain, adrenal gland, liver, thyroid

The cancer progressed after small-cell transformation with adrenal, thyroid, liver and brain involvement, and she died 52.7 months after the original diagnosis from disease progression and organ failure.

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Stage 4 lung cancer: managing pembrolizumab-induced myasthenia gravis

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

Biomarkers: Anti-acetylcholine receptor antibody elevated; TSH elevated during immune-related adverse event workup; cancer biomarkers not reported

At 9 months after the immune-related myasthenia gravis presentation, lung cancer remained in complete response while she continued low-dose prednisolone, pyridostigmine, levothyroxine, and nighttime NIV.

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