Immunotherapy for Stage 4 Lung Cancer: 146 Real Stories

Stage 4 lung cancer: large tumor managed with targeted care

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

Biomarkers: PD-L1 TPS <1%

Metastatic Site: contralateral lymph nodes, supraclavicular lymph…

The patient had a partial response to CheckMate 9LA despite PD-L1 TPS <1%, later progressed after 24 cycles of immunotherapy, received additional chemotherapy, and died in November 20XX+2.

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Stage 4 lung cancer: persistent cough led to diagnosis

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

Biomarkers: KRAS and TP53 ; PD-L1 TPS 95%. Other common lung drivers were not detected.

Metastatic Site: liver, left adrenal gland, lymph nodes, pleural…

After more than 2 years of disease control and partial response on antiangiogenic therapy plus sintilimab, the patient developed fulminant immune-checkpoint-inhibitor-induced type 1 diabetes with severe diabetic ketoacidosis, inflammatory crisis, sepsis, and died shortly after discharge against medical advice.

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Lynch-associated lung and colorectal cancers responded to immunotherapy

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

Biomarkers: dMMR/MSI-H pattern with MLH1/PMS2 loss and germline MLH1 mutation; KRAS and PTEN mutations; PD-L1 TPS 15%.

Metastatic Site: right paraspinal metastatic lesion from lung…

After starting iparomlimab plus tuvonralimab, pleural and pelvic disease improved, intestinal wall involvement decreased further after 5 cycles, the paraspinal lung metastasis remained stable, tumor markers stayed normal, and treatment continued.

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Lung cancer treated with nivolumab: rare kidney inflammation as a side effect

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

Metastatic Site: lung; pleura; lymph nodes

He remained dependent on maintenance hemodialysis after the kidney injury and died from advanced lung cancer 10 months later.

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MET exon 14 skipping lung adenocarcinoma: sequential MET-TKI toxicity and ongoing chemotherapy

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

Biomarkers: MET exon 14 skipping mutation; EGFR negative; ALK negative; ROS1 negative; PD-L1 tumor proportion score 10%

Metastatic Site: pleura

The cancer recurred with pleural dissemination after surgery and adjuvant UFT. Sequential MET inhibitors and systemic therapies provided periods of disease control but were limited by ILD and non-ILD toxicities; at the report, he remained on carboplatin, pemetrexed, and bevacizumab.

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KRAS G12C Stage IV lung adenocarcinoma with synchronous urothelial carcinoma and durable response

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

Biomarkers: Lung adenocarcinoma: KRAS ; PD-L1 TPS 5%. Urothelial carcinoma: GATA3-positive; CK7-positive; TTF1-negative.

Metastatic Site: homolateral pulmonary metastases and N2 lymph nodes…

After enfortumab vedotin, the urothelial carcinoma reached complete radiologic response and the lung cancer remained partially responding/stable; treatment was stopped after 16 months, and PET 2 months later showed complete metabolic response.

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Stage IVA EGFR-mutated lung adenocarcinoma with malignant pleural effusion: stable disease on ivonescimab plus pemetrexed

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

Biomarkers: EGFR exon 19 deletion persisted. Later pleural fluid had PD-L1 TPS 40% / CPS 41, low TMB

Metastatic Site: pleura / malignant pleural effusion

As of August 2025, Stage IVA EGFR-mutated lung adenocarcinoma with malignant pleural effusion was stable on ivonescimab plus pemetrexed after prior progression on gefitinib, almonertinib, and ivonescimab monotherapy.

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Extensive-stage small-cell lung cancer with bone metastases: stable response after durvalumab rechallenge

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

Metastatic Site: bone (axial skeleton and skull)

As of November 2025, the patient continued durvalumab with no recurrent gastritis symptoms, continued response to treatment, and no evidence of disease progression on regular CT and bone-scan surveillance.

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Stage IV squamous lung cancer: complete response followed by fatal bone marrow metastasis

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

Biomarkers: with PD-L1 95%. SCC antigen/CYFRA rose at relapse.

Metastatic Site: bone (spine, bilateral humerus, bilateral femur); bone…

As of December 2025, he had died of aspiration pneumonia 1 month after admission for biopsy-confirmed bone marrow metastasis from squamous lung cancer, despite a prior complete response to chemoimmunotherapy and pembrolizumab maintenance.

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Stage IV NSCLC with brain metastasis and organic psychosis: improvement with blonanserin patch

Patient Info: Anonymized, Male | Stage IV

Metastatic Site: brain, bone

As of December 2025, he was living with Stage IV NSCLC and brain metastases; severe organic psychosis linked to brain metastasis improved with blonanserin transdermal patch, allowing discharge on hospital day 53.

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Stage IV NSCLC with brain and leptomeningeal metastases responding to radiotherapy, camrelizumab, GM-CSF, and chemotherapy

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

Biomarkers: Lung cancer markers supported adenocarcinoma. PD-L1 negative; no common lung driver found; TMB high; MSI not detected.

Metastatic Site: brain, leptomeningeal disease, left supraclavicular…

As of March 2025, leptomeningeal metastases had complete response, brain lesions had further regression, the lung lesion had decreased from 76 mm to 21 mm, and overall disease remained in partial response with 69 months of progression-free survival since radiotherapy.

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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 Pulmonary Lymphoepithelioma-Like Cancer With Pseudoprogression After Immunotherapy and Radiation

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

Biomarkers: EBER positive; no EGFR, ROS1, RAS/RAF or PIK3CA mutations/fusions detected

Through May 2025, follow-up showed no clear evidence of cancer recurrence or metastasis, with progression-free survival exceeding 70 months.

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Stage IV small cell lung cancer: complete tumor response with recovery from paraneoplastic limbic encephalitis

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

Biomarkers: Small-cell lung cancer markers included TTF-1/chromogranin-A with Ki-67 90%. Paraneoplastic testing showed GABA-B receptor IgG positive.

Metastatic Site: adrenal glands, diaphragmatic lymph nodes, lungs,…

After 4 cycles of chemotherapy, PET showed complete tumor response. He was alive, clinically well, fully recovered from neurologic symptoms, and April 2025 brain MRI showed improvement of limbic encephalitis changes with evolution toward hippocampal atrophy.

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Synchronous primary squamous lung cancers: long disease control after multimodal therapy, then Stage IVA lung recurrence

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

Biomarkers: Squamous lung cancers with PD-L1 20% and no driver mutation detected; P40/P63 markers supported squamous type.

Metastatic Site: bilateral lung metastases at recurrence

As of November 2025, the patient had achieved 72 months of progression-free survival and remained alive at 75 months, but had developed Stage IVA recurrent pulmonary squamous cell carcinoma with bilateral lung metastases and had restarted systemic therapy.

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Stage 4 lung cancer: 2-year survival with immunotherapy

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

Biomarkers: SMARCA4/BRG1 loss; MET exon 14 ; BRCA1/MSH6/CDK12 mutations; PD-L1 TPS 90%; no MSI. Other common lung drivers not detected.

Metastatic Site: pleural effusion, multiple bilateral lung nodules,…

The patient declined MET inhibitor therapy and chemotherapy but responded strongly to sintilimab plus anlotinib, with marked shrinkage after 2 cycles, sustained lesion control through 32 cycles, and more than 2 years of progression-free survival.

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Extensive-stage small-cell lung cancer with serplulimab-associated diabetes: care ongoing

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

Biomarkers: Tumor biomarkers not reported. Diabetes workup after immunotherapy: autoantibodies negative, C-peptide very low.

After 11 days in the hospital, diabetic ketoacidosis was controlled; he continued insulin therapy with good glucose control and resumed serplulimab plus levothyroxine.

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Extensive-stage small-cell lung cancer with serplulimab-associated diabetes

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

Biomarkers: Tumor biomarkers not reported. Diabetes autoantibodies were negative, C-peptide was low, and hypothyroidism labs were severe.

After 10 days of hospitalization, diabetic ketoacidosis was controlled; he was discharged on insulin therapy and resumed serplulimab immunotherapy.

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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 IVA right lung squamous cell carcinoma: partial response complicated by camrelizumab-related pneumonitis and pulmonary bullae

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

Biomarkers: Squamous lung cancer marker profile: P40/CK5/6 positive, TTF-1/Napsin A negative. CEA/CYFRA tumor markers were elevated. PD-L1 not reported.

Metastatic Site: suspected pleural involvement / right pleural effusion

The cancer had a partial response to albumin-bound paclitaxel, carboplatin, and camrelizumab; camrelizumab was stopped after suspected immune-related pneumonitis, pulmonary embolism, and reversible pulmonary bullae, which improved after methylprednisolone was resumed.

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Extensive-stage small-cell lung cancer with immune-related diabetes and stable disease at 2 years

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

Biomarkers: Tumor PD-L1 not reported. Immune-related diabetes showed very low C-peptide and negative diabetes autoantibodies; thyroiditis also occurred.

Metastatic Site: pancreas; pleura/pleural effusion; mediastinal lymph…

Two years after the SCLC diagnosis, she was alive with stable oncologic disease after later brain metastases were treated with whole-brain radiotherapy, and she remained insulin-dependent.

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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 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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