Supportive Care for Stage 4 Lung Cancer: 72 Real Stories

ALK-positive lung cancer treated with alectinib throughout pregnancy

Patient Info: Anonymized, Female | Stage IV

Biomarkers: ALK rearrangement / fusion-positive

Metastatic Site: pleura; liver; bone; brain

Alectinib produced a complete radiologic response and maintained intracranial control through pregnancy. She delivered a healthy infant at 37 weeks, with normal development at 26 months.

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First reported case of a severe immune reaction (cytokine release syndrome) from tislelizumab

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

Metastatic Site: pleura (malignant pleural effusion)

The cytokine release syndrome initially improved with high-dose steroids, but he developed severe ventilator-associated pneumonia during the steroid taper and died.

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Lung cancer first discovered through a skin metastasis

Patient Info: Anonymized, Male | Stage IV

Metastatic Site: skin and subcutaneous tissues; soft tissue and muscle;…

His metastatic disease progressed rapidly, and he died 4.5 months after the initial dermatology referral.

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

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

Biomarkers: ALK mutation / ALK-positive

Metastatic Site: Brain | Liver

As of October 2023, Christine was living with Stage IV ALK-positive NSCLC that remained in check on targeted therapy after alectinib cleared brain and liver spots and lorlatinib continued, with significant chronic side effects.

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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 MET Lung Squamous Cell Carcinoma: Amy's Patient Story

Patient Info: Amy, Female | Stage IV

Biomarkers: MET amplification

Metastatic Site: Bone/femur; lymph nodes; shoulder; adrenal glands;…

As of July 2022, Amy had a rapid and strong response to Crizotinib after MET amplification was found, with pain and lumps improving within about 2 weeks after Keytruda had failed.

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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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Facial paralysis from progression of EGFR-positive metastatic lung cancer improved with osimertinib

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

Biomarkers: EGFR exon 21 p.Leu858Arg mutation.

Metastatic Site: brain; leptomeninges and facial nerves

Osimertinib rapidly resolved the bilateral facial weakness and reduced the brain lesions, but after 15 months seizures recurred and three smaller brain metastases had increased in size.

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Likely lung carcinoma presenting as bilateral adrenal metastases

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

Metastatic Site: bilateral adrenal glands

Three months after bilateral adrenalectomy, he remained under regular oncology surveillance, was receiving steroid replacement, and had not required adjuvant chemotherapy.

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Surgery for an isolated splenic metastasis from lung adenocarcinoma

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

Metastatic Site: spleen

Nine months after removal of the isolated splenic metastasis, follow-up showed no local or disseminated recurrence and she remained under regular lung-cancer surveillance.

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More than 10 years living with relapsing extensive-stage small cell lung cancer

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

Biomarkers: Chromogranin-positive.

Metastatic Site: pleura; pancreas; left kidney and perinephric region

After five treatment lines and several metastatic relapses over more than 10 years, his latest irinotecan and carboplatin course produced another partial response and he was doing well at the last follow-up.

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Late-onset mania revealed advanced small cell lung cancer

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

Biomarkers: ACTH-producing tumor with ACTH 776 pg/mL and morning cortisol 206.8 micrograms/dL.

Metastatic Site: right lung; liver

He died a few months after diagnosis from aspiration pneumonia and multiorgan failure in the setting of rapidly deteriorating stage IV small cell lung cancer.

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Erlotinib-related uveitis during treatment for stage IV EGFR-mutated lung cancer

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

Biomarkers: EGFR L858R mutation-positive.

A partial response to erlotinib was maintained at six months, while the uveitis resolved and did not recur after treatment resumed at a lower dose.

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Nivolumab-related adrenal failure during treatment for metastatic lung cancer

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

Metastatic Site: brain (left cerebellum)

Her confusion, gastrointestinal symptoms, and hyponatremia improved after glucocorticoid and mineralocorticoid replacement, and she was discharged on ongoing hormone replacement.

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Lung Cancer Brain Metastases Initially Mistaken for Neurocysticercosis

Patient Info: Anonymized, Female | Stage IV

Metastatic Site: brain

Neurologic disease progressed despite whole-brain radiation, and she died four months after the metastatic lung-cancer diagnosis.

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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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Nivolumab-Related Myocarditis and Heart Block in Metastatic Lung Cancer

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

Metastatic Site: left adrenal gland

He stabilized after high-dose steroids and pacemaker implantation after nivolumab was permanently stopped.

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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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Advanced metastatic lung cancer with bone metastases, pneumonia, and worsening pain

Patient Info: Anonymized, Male | Stage IV

Metastatic Site: Bone

By March 2017, he described worsening metastatic lung cancer with bone lesions, recent pneumonia, severe pain, and concern that AZD9291 might no longer be effective.

Stage IV NSCLC: near-complete response despite severe docetaxel-induced diarrhea

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

As of October 2013, he had completed 6 cycles of weekly docetaxel-cisplatin with dose reduction and supportive care, resulting in a near-complete response.

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Stage IV lung adenocarcinoma with brain metastasis: partial remission after pemetrexed/cisplatin and AOSD-like paraneoplastic syndrome

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

Biomarkers: No tumor molecular biomarkers reported. AOSD-like syndrome had high ferritin, inflammation markers, and RF/ANA negative.

Metastatic Site: brain

As of November 2011, pemetrexed/cisplatin produced partial remission of Stage IV lung adenocarcinoma and controlled the AOSD-like paraneoplastic syndrome without recurrent fever, rash, or arthralgia.

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