Pemetrexed for Stage 4 Lung Cancer: 75 Real Stories

Lung adenocarcinoma that spread to the thyroid 9 years later

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

Metastatic Site: thyroid

After the thyroid metastasis was removed, she started systemic chemotherapy and remained under oncology management.

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Stage IV lung cancer presenting with a paraneoplastic neurologic syndrome and mixed tumor features

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

Biomarkers: PD-L1 0%

Metastatic Site: bone (T10 and L5 vertebrae)

He died after rapid deterioration with severe encephalopathy, weakness and respiratory distress; advanced metastatic lung cancer with progressive paraneoplastic neurologic involvement was considered the most likely cause.

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Stage IVA EGFR-mutant lung adenocarcinoma: clonal evolution, chemoimmunotherapy response, osimertinib rechallenge, and death after progression

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

Biomarkers: Markers changed over time: started with EGFR L747S/L858R; later MET-amplified, PD-L1 TPS 80%, high TMB clone; later EGFR reappeared.

Metastatic Site: pleura, peritoneal nodule, retroperitoneal lymph nodes

The patient died on 30 April 2025 after progression through multiple lines and infection related to treatment-associated myelosuppression.

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Stage IV PD-L1-high lung adenocarcinoma: remission on chemotherapy after tislelizumab-associated KLHL11-IgG cerebellitis

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

Biomarkers: PD-L1-high lung adenocarcinoma with EGFR/ALK/ROS1 wild type and TTF-1 positive. KLHL11-IgG was linked to cerebellitis.

Metastatic Site: M1a disease; specific metastatic site not otherwise…

At 1-year neurologic follow-up, the cerebellitis had markedly improved, serum KLHL11-IgG was negative, brain MRI lesions had resolved, and lung adenocarcinoma remained in remission on cisplatin plus pemetrexed.

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Stage IV EGFR-mutated lung adenocarcinoma: high-dose furmonertinib after CNS progression

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

Biomarkers: Initial EGFR L858R mutation. Later blood testing showed EGFR p.S553Y variation; CEA rose and fell with treatment.

Metastatic Site: brain/meninges; bilateral pleura/lungs; mediastinal…

As of June-September 2024, the left lung lesion was stable to slightly smaller on escalated furmonertinib, but brain/CNS lesions had progressed and required dose escalation to 240 mg/day; later imaging was declined.

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Stage IV EGFR-mutated lung cancer responds after targeted therapy intolerance

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

Biomarkers: EGFR L858R mutation; PIK3CA E545K mutation; acquired ROS1 rearrangement

Metastatic Site: pleura|pericardium|bone|lungs

Chemotherapy produced a partial response that remained sustained for 7 months at the latest follow-up.

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More than 5 years of disease control with maintenance chemotherapy for Stage IV lung cancer

Patient Info: Anonymized, Male | Stage IV

Biomarkers: KRAS mutation; TP53 mutation

Metastatic Site: brain

After more than 60 months of follow-up and prolonged maintenance chemotherapy, the latest assessment found no evidence of current tumor progression.

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Stage IV squamous lung cancer with steroid-refractory immune-related gastritis after pembrolizumab

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

Biomarkers: Gastric biopsy during immune gastritis showed CD8-positive lymphocyte inflammation, no cancer

After about 2 years of carboplatin, pemetrexed, and pembrolizumab, lung cancer treatment was stopped because of tumor growth; the later immune-related gastritis improved after escalation to infliximab, while the cancer course remained a setback/progression story.

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Stage IV EGFR-positive lung cancer treated for nearly 5 years before progression

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

Biomarkers: EGFR L858R mutation

Metastatic Site: liver

The cancer later progressed despite chemotherapy, and he died from lung cancer 4 years and 8 months after diagnosis.

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EGFR-mutant lung adenocarcinoma with acquired ROS1 rearrangement after EGFR-TKI resistance

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

Biomarkers: EGFR exon 19 deletion; acquired EGFR T790M; acquired EZR exon10-ROS1 exon34 rearrangement

Metastatic Site: bone (distal femur); contralateral lung;…

After fourth-line crizotinib for acquired EZR-ROS1 rearrangement, response evaluation on August 27, 2025 showed partial response, and September 2025 bone scan showed stable bone lesions.

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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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EGFR-Mutant Lung Adenocarcinoma With Bone and Leptomeningeal Metastases

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

Biomarkers: EGFR exon 19 deletion; acquired EGFR T790M mutation

Metastatic Site: bone, leptomeninges

In May 2025, leptomeningeal disease remained present and he continued combination chemotherapy with bevacizumab and high-dose furmonertinib, leaving hospital in stable condition after cycle 8.

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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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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 IV EGFR-mutated lung adenocarcinoma with suspected myocardial metastasis responding to afatinib plus chemotherapy

Patient Info: Anonymized, Male | Stage IV

Biomarkers: EGFR L861Q; PD-L1 TPS/CPS 65%. TP53, MET and PIK3CA alterations also reported.

Metastatic Site: left ventricular myocardium; mediastinal lymph nodes…

As of December 2025, the suspected left-ventricular myocardial metastasis had shrunk after 2 courses of afatinib plus pemetrexed/cisplatin, and the patient had no cardiovascular events during monitoring.

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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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Stage IVB EGFR L861R lung adenocarcinoma treated with afatinib, osimertinib, and chemotherapy

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

Biomarkers: EGFR L861R mutation; CEA 5.5 ng/mL; CYFRA 21-1 5.1 ng/mL

Metastatic Site: lymph nodes, lung, bone

As of September 2025, the patient remained alive 27 months after diagnosis after multiple EGFR-targeted and chemotherapy lines.

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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 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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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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