Pemetrexed for Stage 4 Lung Cancer: 75 Real Stories

Stage IVA lung adenocarcinoma with solitary brain metastasis: pCR after brain surgery, chemoradiation, immunotherapy, and lobectomy

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

Biomarkers: PD-L1 75%; negative for driver gene mutations and translocations

Metastatic Site: brain

As of May 2024, he had no recurrence after brain metastasis resection and radiation, carboplatin/pemetrexed/atezolizumab, robot-assisted right upper lobectomy with pathologic complete response, and 13 cycles of maintenance atezolizumab.

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Stage 4 lung adenocarcinoma: complete response on immunotherapy combination

Patient Info: Anonymized, Male | Stage IV

Biomarkers: No targetable mutation found. Tissue showed TP53/ARID1A; liquid biopsy added KEAP1, and SMARCA4. PD-L1 not evaluable.

Metastatic Site: bilateral lung nodules, left adrenal gland

As of May 2024, metastatic lung adenocarcinoma had a complete radiologic response lasting more than 14 months on pembrolizumab maintenance, and a new PET-avid lung nodule was benign inflammation rather than cancer.

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Rare lung cancer first discovered as a mass in the skull

Patient Info: Anonymized, Male | Stage IV

Biomarkers: KRAS ; CK7-positive; CDX2-positive; pathology favoured pulmonary enteric adenocarcinoma

Metastatic Site: skull base / sphenoid sinus; right posterior acetabulum

He received palliative radiation and prolonged systemic therapy, completing 35 cycles including 31 maintenance cycles of pemetrexed and pembrolizumab.

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Brain radiation therapy complication (radionecrosis) potentially linked to combined chemo-immunotherapy

Patient Info: Anonymized, Female | Stage IV

Biomarkers: PD-L1 0%; tumour mutational burden 33 mutations/Mb; TP53 mutation at diagnosis; later ctDNA included KEAP1 and NOTCH3 alterations

Metastatic Site: brain; presumed leptomeningeal disease

She recovered completely from surgery for radiation necrosis, resumed cancer treatment and remained neurologically intact at 18 months. She was found deceased 9 months later; the cause of death was unknown.

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BRCA2-Mutated Metastatic Lung Adenocarcinoma Controlled for 30 Months With Olaparib

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

Biomarkers: PD-L1-negative; BRCA2 mutation; ATM mutation; EGFR-negative; ALK-negative

Metastatic Site: brain

Olaparib provided about 30 months of disease control, and PET imaging remained overall stable when a separate new breast primary was found in February 2023.

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MET-mutated lung cancer: testing savolitinib before surgery

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

Biomarkers: MET exon 14 skipping, TP53 and BRAF mutations; PD-L1 expression 5%

Metastatic Site: pleura; mediastinal lymph node

Savolitinib produced a partial radiological response, but surgery confirmed persistent pleural and mediastinal nodal metastases with ypStage IVA disease. He recovered and continued adjuvant savolitinib.

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HER2-positive metastatic lung cancer treated with trastuzumab deruxtecan (Enhertu)

Patient Info: Anonymized, Female | Stage IV

Biomarkers: ERBB2/HER2 copy-number gain of at least 20 copies; TP53 C242fs; CDK12 copy-number gain; tumour mutational burden 3.2 mutations/Mb

Metastatic Site: lungs / multiple pulmonary nodules

Trastuzumab deruxtecan reduced the pulmonary nodules by more than 50% at 3 months and produced a documented response lasting 13.8 months.

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Stage IV Lung Cancer Reached Remission After Severe Nerve Damage and Neck Surgery

Patient Info: Anonymized, Female | Stage IV

Metastatic Site: left cervical lymph nodes

Considered in complete remission after cervical lymph-node surgery, with no clinical or radiological progression 24 months after systemic treatment; alive and back at work 3 years after diagnosis.

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Long-term erlotinib treatment alongside worsening kidney vasculitis

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

Metastatic Site: bone

Bone metastases showed osteosclerotic change after erlotinib began, and the drug continued because he was benefiting from treatment despite worsening renal vasculitis.

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A painful scalp metastasis from sarcomatoid lung cancer

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

Biomarkers: No targetable mutations identified; CAM5.2-positive; p63-positive; CD10-positive; vimentin-positive.

Metastatic Site: chest wall and rib; liver; right gluteal region; scalp…

Her disease progressed with a further liver lesion and additional metastatic complications, and systemic treatment was stopped because of severe immune-related toxicity and the absence of targetable mutations.

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A regressed choroidal metastasis during EGFR-targeted lung cancer treatment

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

Biomarkers: EGFR exon 19 deletion.

Metastatic Site: liver; bone; central nervous system; right choroid

The right choroidal metastasis appeared inactive and regressed during systemic treatment, visual acuity remained 20/20, and no local eye treatment was required.

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Stage IV Mucinous Lung Cancer Treated With Afatinib and Surgery

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

Biomarkers: CD74-NRG1 fusion; ALK/ROS1/EGFR/BRAF/KRAS/MET/HER2 wild type; PD-L1 initially not expressed and later 0%-20%

Metastatic Site: bilateral lungs|bone|right adrenal gland

She was alive and receiving treatment after bone and right-adrenal progression at the latest follow-up.

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Metastatic Lung Cancer Responded Completely After a Change in Immunotherapy

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

Biomarkers: TTF-1-positive; napsin-positive; PD-L1 0%; high tumour mutational burden; no actionable mutations

Metastatic Site: bone (left iliac bone, acetabulum and thoracic…

After progression on nivolumab, atezolizumab produced a complete response by the 6-month scan; after 35 cycles, the response remained sustained, he was alive and well, and no immune-related adverse effects were documented.

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Osimertinib rechallenge after severe pneumonitis in Stage IV lung cancer

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

Biomarkers: EGFR exon 19 deletion; acquired EGFR T790M mutation

Metastatic Site: pleura, liver, bone, leptomeninges

She initially regained a significant response after osimertinib rechallenge without recurrent pneumonitis, but developed progressive leptomeningeal disease after 11 months.

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Long-Term Nivolumab Response With Thyroid and Adrenal Side Effects

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

Nivolumab remained ongoing at course 82, tumor burden had fallen to one-fifth of baseline, and no disease progression was documented.

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Osimertinib Improved Spinal Cord Metastases in Long-Standing Lung Cancer

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

Biomarkers: Initial surgical specimen: no detected EGFR mutation and ALK-negative. Later pleural-fluid tumor: acquired EGFR T790M mutation with no other detected EGFR mutation.

Metastatic Site: cervical and mediastinal lymph nodes; bone; brain;…

Osimertinib improved neurologic function and kept the lung cancer stable for 14 months; he later died from bacterial pneumonia.

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Rapidly Progressive Stage IV Lung Adenocarcinoma With a Miliary Imaging Pattern

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

Biomarkers: TTF-1-positive; p40-negative; chromogranin-negative; synaptophysin-negative; EGFR-negative; ALK-negative; ROS1-negative; PD-L1 expression 5%–10%.

The cancer progressed rapidly, and he died approximately four months after diagnosis while being transported to inpatient hospice.

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Hormone Problems During Nivolumab Treatment for Advanced Lung Cancer

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

Biomarkers: EGFR/ALK/ROS1/BRAF wild type

Metastatic Site: abdominal wall|brain

She was living with Stage IVA lung cancer after about 1 year of nivolumab. Thyroid levels normalized after levothyroxine adjustment, and continued endocrine monitoring was planned for treatment-related pituitary dysfunction.

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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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EGFR-Mutated Stage IV Lung Adenocarcinoma With Painful Finger Lesions During Osimertinib

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

Biomarkers: EGFR-mutated; EGFR T790M-positive at relapse

She remained on active osimertinib treatment; the finger lesions persisted but were controlled with colloidal oatmeal.

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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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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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