Pemetrexed: 114 Real Stories

Durable brain and leptomeningeal response to pembrolizumab in Stage IV lung cancer

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

Biomarkers: PD-L1 high positive; EGFR negative; BRAF negative; KRAS negative; ROS1 negative; ALK negative

Metastatic Site: right adrenal gland, left sixth rib, brain,…

After 29 pembrolizumab cycles over 20 months, imaging showed no leptomeningeal disease, resolution of 3 brain lesions and marked reduction of the dominant frontal lesion; she remained neurologically intact and radiographically stable.

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EGFR-Mutated Stage IV Lung Adenocarcinoma With Painful Finger Lesions During Osimertinib

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

Biomarkers: EGFR-mutated; EGFR T790M-positive at relapse

She remained on active osimertinib treatment; the finger lesions persisted but were controlled with colloidal oatmeal.

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Autoimmune hemolytic anemia after 39 cycles of nivolumab for metastatic lung cancer

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

Metastatic Site: liver, bone

While nivolumab remained on hold, his lung cancer was stable on imaging and clinically, and hemoglobin had recovered to 14.6 g/dL about 4 months after high-dose prednisone and rituximab began.

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ERBB2-Mutated Stage III Lung Cancer With Liver Recurrence and Multiple Lines of Therapy

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

Biomarkers: ERBB2 exon 20 insertion

Metastatic Site: liver

After 6 months of disease control on vinorelbine plus trastuzumab, the cancer progressed in all sites and she chose hospice care.

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Stage IV ERBB2-Mutated Lung Adenocarcinoma Responding to HER2-Targeted Therapy

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

Biomarkers: ERBB2 exon 20 insertion

Metastatic Site: bilateral lungs

Afatinib showed a response after 1 month, but insurance denial required a return to trastuzumab-based treatment.

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Stage IV ERBB2-Mutated Lung Cancer With Extensive Bone Metastases

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

Biomarkers: ERBB2 exon 20 insertion. A PIK3CA mutation was later detected at progression and considered a possible resistance mechanism.

Metastatic Site: bone

After progression on pemetrexed following several earlier treatment lines, she transitioned to hospice care.

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Stage IV ERBB2-Mutated Lung Adenocarcinoma With Brain Metastases and Multiple Targeted Therapies

Patient Info: Anonymized, female, Under 40 | Stage IV

Biomarkers: ERBB2 exon 20 insertion, exact sequence not specified. ERBB2 copy-number gain was identified during progression on afatinib.

Metastatic Site: brain, adrenal gland, liver

The final documented afatinib plus bevacizumab rechallenge produced a mixed response followed by liver progression after 3 months.

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ERBB2-Mutated Metastatic Lung Adenocarcinoma With Leptomeningeal Progression

Patient Info: Anonymized, male

Biomarkers: ERBB2 A775_G776 insYVMA mutation with amplification

The final treatment produced a mixed systemic response, but leptomeningeal disease developed.

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ERBB2-Mutated Metastatic Lung Adenocarcinoma With Treatment Intolerance and Progression

Patient Info: Anonymized, male

Biomarkers: ERBB2 A775_G776 insYVMA mutation

After poorly tolerated earlier regimens with stable disease, he developed symptomatic progression during 1 month of afatinib.

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ERBB2-Mutated Metastatic Lung Adenocarcinoma Progressing Through Multiple Therapies

Patient Info: Anonymized, female

Biomarkers: ERBB2 mutation

The cancer progressed during afatinib, nivolumab and a later paclitaxel rechallenge.

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ERBB2-Mutated Metastatic Lung Adenocarcinoma With Progression Across Multiple Regimens

Patient Info: Anonymized, male

Biomarkers: ERBB2 V777delinsVGSP mutation

After a brief period of stable disease on cisplatin plus docetaxel, the cancer progressed through erlotinib, gemcitabine and afatinib.

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ERBB2-Mutated Metastatic Lung Adenocarcinoma With Limited Disease Control Across Multiple Therapies

Patient Info: Anonymized, female

Biomarkers: ERBB2 V776delinsVC mutation

After temporary stable disease when bevacizumab was added to chemotherapy, the cancer progressed on trastuzumab plus paclitaxel and then erlotinib.

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Lung Cancer: Diego's Patient Story

Patient Info: Diego, Male | Stage Metastatic/Advanced

Metastatic Site: Hip / left iliac region pain treated with radiotherapy

On 27 March 2017, Diego was recovering from hospitalization and radiotherapy for severe hip/left iliac-region pain, with pain improved and pemetrexed chemotherapy planned after his next oncology visit.

Lung Cancer Presenting With Tongue and Gastrointestinal Metastases

Patient Info: Anonymized, male, 40s

The cancer progressed after 2 cycles of carboplatin and pemetrexed, with worsening performance status, and chemotherapy was stopped.

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Synchronous Stage IA breast cancer and Stage IIA lung adenocarcinoma: disease-free after surgery and adjuvant therapy

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

Biomarkers: Breast tumor: ER/PR positive, HER2 negative. Lung tumor: KRAS/EGFR wild type, ALK rearrangement not detected.

As of April 2014, more than 2 years of follow-up showed no recurrent disease after treatment of synchronous Stage IA breast cancer and Stage IIA lung adenocarcinoma.

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Stage IIIB lung adenocarcinoma with separate papillary renal cell carcinoma: doing well more than 6 years after revised diagnosis

Patient Info: Anonymized, Female, 40s | Stage III

Biomarkers: Lung tumor: TTF-1-positive; PET-avid. Kidney lesion: PET-negative; later papillary renal cell carcinoma. No lung molecular biomarkers reported.

As of February 2014, she was doing well more than 6 years after the initial diagnosis, after the diagnosis was revised from presumed Stage IV lung cancer to Stage IIIB lung adenocarcinoma plus a separate papillary renal cell carcinoma.

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EGFR L858R-mutant Stage IV lung adenocarcinoma managed after gefitinib-induced lung injury

Patient Info: Anonymized, Male, 40s | Stage IV

Biomarkers: EGFR L858R mutation

Metastatic Site: liver, bone, hilar lymph nodes, mediastinal lymph…

Gefitinib produced early tumor shrinkage but was stopped for interstitial lung disease; subsequent carboplatin, pemetrexed, and bevacizumab produced a good response, while variceal bleeding was controlled with endoscopic treatment.

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Stage IV lung adenocarcinoma with brain metastasis: partial remission after pemetrexed/cisplatin and AOSD-like paraneoplastic syndrome

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

Biomarkers: No tumor molecular biomarkers reported. AOSD-like syndrome had high ferritin, inflammation markers, and RF/ANA negative.

Metastatic Site: brain

As of November 2011, pemetrexed/cisplatin produced partial remission of Stage IV lung adenocarcinoma and controlled the AOSD-like paraneoplastic syndrome without recurrent fever, rash, or arthralgia.

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