Pemetrexed for Stage 4 Lung Cancer: 75 Real Stories

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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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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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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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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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 adenocarcinoma with RET fusion responding to pralsetinib

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

Biomarkers: RET fusion

Metastatic Site: pleura

As of March 2025, he had recovered from grade 3 Pneumocystis jirovecii pneumonia, restarted pralsetinib, and had no progressive disease or recurrence of adverse events over 13 months.

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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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Lung Adenocarcinoma With Rare Skin Metastasis to the Neck

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

Metastatic Site: neck skin

The lung cancer later spread to the neck skin, and he died during the following year after stopping further treatment.

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Advanced Non-Small Cell Lung Cancer With ERBB2 and TP53 Mutations

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

Biomarkers: ERBB2 exon 20 Y772-A775dup mutation; TP53 mutation; PD-L1 TPS 0%

Metastatic Site: liver, bone, both lungs

Imaging after treatment showed stable disease, and he remained in good condition while continuing maintenance pemetrexed and bevacizumab.

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Metastatic Lung Adenocarcinoma With a Serious Immune-Therapy Pituitary Complication

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

Biomarkers: No detected EGFR, ALK, ROS1, RET, MET or HER2 alterations

Metastatic Site: brain, meninges, skull, bone, pituitary

The cancer had progressed to extensive brain, skull and bone involvement after several treatments. Steroid treatment improved the severe thirst, high urine output and other symptoms from immune-related hypophysitis.

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MET Y1003N-Mutant Lung Adenocarcinoma Responding to Tepotinib

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

Biomarkers: MET mutation

Metastatic Site: bone

Tepotinib produced an 8-month response after many earlier treatments, but the cancer later recurred and she died about 3 years after treatment began.

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Stage IV lung adenocarcinoma: ROS1 fusion detected after immunotherapy resistance and partial response to entrectinib

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

Biomarkers: Initial lung adenocarcinoma markers supported lung origin; PD-L1 <1%, no target found at first. Later testing found CD74-ROS1 fusion.

Metastatic Site: brain, bilateral lung lesions

As of December 2024, repeat imaging after entrectinib showed partial response in lung disease and regression of brain metastases, with the patient stable and willing to continue treatment.

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Stage IV Lung Adenocarcinoma With Delayed Pembrolizumab-Related Pneumonitis

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

Metastatic Site: contralateral lung

After brachytherapy and continued pembrolizumab, imaging 1 year later showed a smaller right hilar lesion with otherwise stable disease. She later recovered from delayed pembrolizumab-related pneumonitis after immunotherapy had been stopped.

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Lung Adenocarcinoma With Immune-Related Abdominal Inflammation and Later Bone Progression

Patient Info: Anonymized, male | Stage IV

Biomarkers: PD-L1 30%; KRAS G13X mutation; EGFR/ALK/ROS1 negative

Metastatic Site: bone

After several periods of response or stability, lymph-node progression recurred and bone progression was documented in July 2024. Another treatment line was being planned.

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Metastatic Lung Cancer With Morphine-Induced Fever During Palliative Radiation

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

Metastatic Site: brain, bone

She remained on dacomitinib while receiving radiation for painful metastatic disease in 2022. After morphine was identified as the cause of recurrent fever and stopped, her symptoms resolved and she was discharged in satisfactory condition.

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Stage 4 lung cancer: stable disease on immunotherapy combination

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

Biomarkers: TP53, and MSH2 mutations; PD-L1 locally positive; Ki-67 20%; ALK negative. Markers otherwise supported lung cancer.

Metastatic Site: left atrium, right adrenal gland, skull; hilar and…

Stage IVB NSCLC remained clinically stable during carboplatin, pemetrexed, and tislelizumab, but treatment was stopped because of financial and psychological burden; later cancer status was not reported.

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Stage 4 lung cancer: immunotherapy plus particle therapy halts progression

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

Biomarkers: PD-L1 90%; high tumor mutational burden; PIK3CA ; TP53 mutation; MET mutation

Metastatic Site: left proximal femur

Stage IV oligometastatic NSCLC had good CT response to carboplatin, pemetrexed, and pembrolizumab, then no disease progression 6 months after PULSAR radiotherapy plus pembrolizumab; grade 2 pneumonitis improved with prednisone.

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Stage IV Non-Small Cell Lung Cancer: Lenny's Survivor Story

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

Biomarkers: PD-L1 expression positive

Metastatic Site: right femur; brain/cerebellum

As of July 2024, Lenny described himself as NED/no evidence of disease after surgery, CyberKnife radiation, chemotherapy, and Keytruda-based immunotherapy.

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