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

What happened, in summary

A man in his 60s was found to have a left lower-lobe lung mass while being treated for COVID-19 in January 2021. Biopsy confirmed Stage III lung adenocarcinoma. Tumor testing showed PD-L1 expression of 30% and a KRAS G13X mutation, while EGFR, ALK and ROS1 testing was negative.

He began cisplatin, pemetrexed and pembrolizumab in March 2021. Cisplatin was changed to carboplatin during the second cycle because of kidney-function changes. After 4 cycles, the cancer had partially responded, and he continued pemetrexed with pembrolizumab. During treatment he developed immune-related arthritis and painful inflammation of the abdominal mesentery, which improved with steroids. He also received stereotactic radiation to the lung lesion.

After a period of observation, thoracic and cervical lymph nodes progressed in 2022. He started docetaxel with nintedanib. Later biopsies initially showed an inflammatory sarcoidosis-like reaction rather than clear cancer, but a subsequent biopsy confirmed adenocarcinoma in a lymph node, and treatment was restarted.

By January 2024, lymph nodes were progressing again, so he switched to gemcitabine. The disease was stable in April, but bone progression was found in July 2024 and another treatment line was being planned.