What happened, in summary

A woman in her 50s, a former smoker with asthma and hypothyroidism, developed a persistent cough and shortness of breath with activity. Changes to her asthma medicines did not help, and she received antibiotics for presumed pneumonia twice within 1 year without improvement. She was eventually diagnosed with stage IV lung adenocarcinoma and was told her life expectancy might be 1–2 years.

She began palliative pembrolizumab with pemetrexed and carboplatin. After febrile neutropenia, the chemotherapy doses were reduced to 75% from cycle 2. After 7 cycles, her liver enzymes rose, and she developed severe numbness and pain in her hands that made everyday tasks difficult. Treatment stopped after 8 cycles. The nerve symptoms began easing within 3–4 weeks and fully resolved within 6 months.

Despite stopping treatment, scans showed continued improvement. The primary tumor had shrunk 22% after 3 cycles and 44% on the first scan after discontinuation. By 8 months, it was no longer measurable. At 12 months, however, PET/CT showed active lymph nodes on the left side of her neck. A needle sample confirmed metastatic lung adenocarcinoma. Because restarting chemoimmunotherapy risked bringing back the severe neuropathy, she chose surgery. Four of 10 removed cervical lymph nodes contained cancer, and radiation was not recommended.

At 24 months after systemic treatment, she had no clinical or radiological progression and was considered in complete remission. Three years after diagnosis, she was alive and had returned to work 15–21 hours a week. Fatigue and anxiety continued to affect her, but consistent face-to-face follow-up with the same doctor gave her greater comfort.