Pemetrexed: 114 Real Stories

Stage 4 lung cancer: managing pembrolizumab-induced myasthenia gravis

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

Biomarkers: Anti-acetylcholine receptor antibody elevated; TSH elevated during immune-related adverse event workup; cancer biomarkers not reported

At 9 months after the immune-related myasthenia gravis presentation, lung cancer remained in complete response while she continued low-dose prednisolone, pyridostigmine, levothyroxine, and nighttime NIV.

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Stage 4 lung adenocarcinoma with RET fusion responding to pralsetinib

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

Biomarkers: RET fusion

Metastatic Site: pleura

As of March 2025, he had recovered from grade 3 Pneumocystis jirovecii pneumonia, restarted pralsetinib, and had no progressive disease or recurrence of adverse events over 13 months.

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Lung Adenocarcinoma With Rare Skin Metastasis to the Neck

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

Metastatic Site: neck skin

The lung cancer later spread to the neck skin, and he died during the following year after stopping further treatment.

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Advanced Non-Small Cell Lung Cancer With ERBB2 and TP53 Mutations

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

Biomarkers: ERBB2 exon 20 Y772-A775dup mutation; TP53 mutation; PD-L1 TPS 0%

Metastatic Site: liver, bone, both lungs

Imaging after treatment showed stable disease, and he remained in good condition while continuing maintenance pemetrexed and bevacizumab.

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Metastatic Lung Adenocarcinoma With a Serious Immune-Therapy Pituitary Complication

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

Biomarkers: No detected EGFR, ALK, ROS1, RET, MET or HER2 alterations

Metastatic Site: brain, meninges, skull, bone, pituitary

The cancer had progressed to extensive brain, skull and bone involvement after several treatments. Steroid treatment improved the severe thirst, high urine output and other symptoms from immune-related hypophysitis.

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MET Y1003N-Mutant Lung Adenocarcinoma Responding to Tepotinib

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

Biomarkers: MET mutation

Metastatic Site: bone

Tepotinib produced an 8-month response after many earlier treatments, but the cancer later recurred and she died about 3 years after treatment began.

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Stage IV lung adenocarcinoma: ROS1 fusion detected after immunotherapy resistance and partial response to entrectinib

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

Biomarkers: Initial lung adenocarcinoma markers supported lung origin; PD-L1 <1%, no target found at first. Later testing found CD74-ROS1 fusion.

Metastatic Site: brain, bilateral lung lesions

As of December 2024, repeat imaging after entrectinib showed partial response in lung disease and regression of brain metastases, with the patient stable and willing to continue treatment.

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Stage IV Lung Adenocarcinoma With Delayed Pembrolizumab-Related Pneumonitis

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

Metastatic Site: contralateral lung

After brachytherapy and continued pembrolizumab, imaging 1 year later showed a smaller right hilar lesion with otherwise stable disease. She later recovered from delayed pembrolizumab-related pneumonitis after immunotherapy had been stopped.

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

Patient Info: Anonymized, male | Stage IV

Biomarkers: PD-L1 30%; KRAS G13X mutation; EGFR/ALK/ROS1 negative

Metastatic Site: bone

After several periods of response or stability, lymph-node progression recurred and bone progression was documented in July 2024. Another treatment line was being planned.

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Recurrent Lung Adenocarcinoma Complicated by a Tracheopericardial Fistula

Patient Info: Anonymized, male, 70+ | Stage II

Biomarkers: No gene mutations identified on postoperative testing

He died during the June 2024 admission, about 7½ years after his November 2016 lung-cancer diagnosis, after massive hemoptysis occurred in the setting of a tracheopericardial fistula and recurrent cancer.

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Stage III Lung Adenocarcinoma Treated With Complex Lung-Sparing Surgery and Adjuvant Therapy

Patient Info: Anonymized, male, Under 40 | Stage III

Biomarkers: PD-L1 high expression

Follow-up through 3 years after surgery showed no recurrence or metastasis, with stable lung function and unrestricted physical activity.

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Metastatic Lung Cancer With Morphine-Induced Fever During Palliative Radiation

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

Metastatic Site: brain, bone

She remained on dacomitinib while receiving radiation for painful metastatic disease in 2022. After morphine was identified as the cause of recurrent fever and stopped, her symptoms resolved and she was discharged in satisfactory condition.

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Stage 4 lung cancer: stable disease on immunotherapy combination

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

Biomarkers: TP53, and MSH2 mutations; PD-L1 locally positive; Ki-67 20%; ALK negative. Markers otherwise supported lung cancer.

Metastatic Site: left atrium, right adrenal gland, skull; hilar and…

Stage IVB NSCLC remained clinically stable during carboplatin, pemetrexed, and tislelizumab, but treatment was stopped because of financial and psychological burden; later cancer status was not reported.

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Stage 4 lung cancer: immunotherapy plus particle therapy halts progression

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

Biomarkers: PD-L1 90%; high tumor mutational burden; PIK3CA ; TP53 mutation; MET mutation

Metastatic Site: left proximal femur

Stage IV oligometastatic NSCLC had good CT response to carboplatin, pemetrexed, and pembrolizumab, then no disease progression 6 months after PULSAR radiotherapy plus pembrolizumab; grade 2 pneumonitis improved with prednisone.

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Stage IV Non-Small Cell Lung Cancer: Lenny's Survivor Story

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

Biomarkers: PD-L1 expression positive

Metastatic Site: right femur; brain/cerebellum

As of July 2024, Lenny described himself as NED/no evidence of disease after surgery, CyberKnife radiation, chemotherapy, and Keytruda-based immunotherapy.

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EGFR-mutant lung adenocarcinoma in Li-Fraumeni syndrome: relapse-free after lobectomy and chemotherapy

Patient Info: Anonymized, Female, 40s

Biomarkers: Lung tumor had EGFR exon 19 deletion. Germline TP53 variant was consistent with Li-Fraumeni syndrome; prior breast cancers were HER2 positive.

As of July 2024, she was free of relapse 2 years after left inferior lobectomy and pemetrexed/cisplatin for EGFR exon 19 deletion lung adenocarcinoma.

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Stage IVA lung adenocarcinoma with solitary brain metastasis: pCR after brain surgery, chemoradiation, immunotherapy, and lobectomy

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

Biomarkers: PD-L1 75%; negative for driver gene mutations and translocations

Metastatic Site: brain

As of May 2024, he had no recurrence after brain metastasis resection and radiation, carboplatin/pemetrexed/atezolizumab, robot-assisted right upper lobectomy with pathologic complete response, and 13 cycles of maintenance atezolizumab.

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Stage 4 lung adenocarcinoma: complete response on immunotherapy combination

Patient Info: Anonymized, Male | Stage IV

Biomarkers: No targetable mutation found. Tissue showed TP53/ARID1A; liquid biopsy added KEAP1, and SMARCA4. PD-L1 not evaluable.

Metastatic Site: bilateral lung nodules, left adrenal gland

As of May 2024, metastatic lung adenocarcinoma had a complete radiologic response lasting more than 14 months on pembrolizumab maintenance, and a new PET-avid lung nodule was benign inflammation rather than cancer.

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Rare lung cancer first discovered as a mass in the skull

Patient Info: Anonymized, Male | Stage IV

Biomarkers: KRAS ; CK7-positive; CDX2-positive; pathology favoured pulmonary enteric adenocarcinoma

Metastatic Site: skull base / sphenoid sinus; right posterior acetabulum

He received palliative radiation and prolonged systemic therapy, completing 35 cycles including 31 maintenance cycles of pemetrexed and pembrolizumab.

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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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Severe colitis from pembrolizumab immunotherapy requiring additional treatment

Patient Info: Anonymized, Male

Infliximab stopped the bleeding and reduced bowel movements from 11–12 to about 3–4 per day within 1 week, allowing discharge. Continued follow-up was needed for the colitis, hepatitis B reactivation risk and lung cancer.

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BRCA2-Mutated Metastatic Lung Adenocarcinoma Controlled for 30 Months With Olaparib

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

Biomarkers: PD-L1-negative; BRCA2 mutation; ATM mutation; EGFR-negative; ALK-negative

Metastatic Site: brain

Olaparib provided about 30 months of disease control, and PET imaging remained overall stable when a separate new breast primary was found in February 2023.

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Lung cancer in a young adult mistaken for recurring pneumonia

Patient Info: Anonymized, Male | Stage III

Biomarkers: KRAS mutation

Two months after discharge, he began carboplatin, pemetrexed and pembrolizumab and had received 2 cycles.

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Lung cancer immunotherapy causing sudden heart inflammation and type 1 diabetes

Patient Info: Anonymized, Female | Stage III

Her acute symptoms resolved, cardiac function returned to her baseline ejection fraction of 32% at 1 month and durvalumab remained permanently discontinued while oncology, endocrine and cardiac follow-up continued.

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