What happened, in summary

A 54-year-old man was found to have a 6.7 × 6.0 cm mass in the left upper lung during a medical check. Biopsy confirmed squamous cell lung carcinoma. His kidney function was normal, and imaging showed no metastases. He underwent left upper lobectomy, and pathology classified the cancer as Stage IIIA, pT4N1M0. Adjuvant chemotherapy was considered but not received.

Several months later, a single brain metastasis was treated with Gamma Knife radiosurgery. The cancer then spread through both kidneys and the lungs. Because the original tumor strongly expressed PD-L1, he received 3 cycles of pembrolizumab, but the disease continued to progress. His kidneys enlarged with multiple metastatic deposits, and his creatinine rose from 0.71 mg/dL to 20.79 mg/dL. Hemodialysis was started and continued 3 times each week.

He then received carboplatin plus paclitaxel, with 2 courses given during the admission. After discharge, he returned within 4 days with fever, severe shortness of breath, low oxygen levels, and extensive lung changes with pleural fluid. Antibiotics and fluid removal during dialysis did not reverse the respiratory decline. He died 5 days after readmission. The exact cause of the final respiratory illness was not confirmed because no autopsy was performed.