What happened, in summary

A 74-year-old man with a long smoking history was diagnosed with Stage IV squamous cell cancer of the left lung with a rib metastasis. He first received nab-paclitaxel and carboplatin with tislelizumab, but developed a widespread rash after the first cycle. Treatment then changed to 5 cycles of gemcitabine plus carboplatin followed by 5 cycles of gemcitabine alone. When imaging showed progression, he received 9 cycles of tislelizumab monotherapy. Further progression caused bone destruction, and another tislelizumab treatment was given with bone-directed therapy. Before continuing immunotherapy, testing showed low morning cortisol and ACTH levels. After multidisciplinary review, he was diagnosed with adrenal insufficiency related to the immune checkpoint inhibitor and started steroid replacement. Tislelizumab was deferred. More than 7 months later, cortisol remained markedly low and immunotherapy had not resumed. The latest chest CT showed the lung lesions were similar to the previous examination, supporting a stable-disease status after the earlier progression.