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Background <p>The outcomes of untreated patients with lung adenocarcinoma with brain metastasis are poor; the usual survival period was around weeks to 3&#xa0;months. While molecularly targeted agents and immune checkpoint inhibitors demonstrate survival benefits in selected populations, significant access barriers persist, particularly among socioeconomically disadvantaged groups. This report details exceptional survival duration in a KRAS p.Q61H/TP53 co-mutant case, exceeding conventional survival estimates and necessitating strategies to overcome system-level care constraints.</p> Case presentation <p>A male Asian patient aged 70–80&#xa0;years presented with bilateral pulmonary lobe lesions (largest: 57&#xa0;mm in left inferior lobe) and a 14-mm right frontal lobe metastasis. Histopathological and immunohistochemical analysis confirmed stage IV pulmonary adenocarcinoma, with genomic testing revealing co-mutations in KRAS exon 3 c.183A &gt; C (p.Q61H) and TP53 exon 7 c.738G &gt; A (p.R247K). The patient received pemetrexed–cisplatin chemotherapy, radiotherapy, and palliative surgery. Mild adverse events (drug eruption, elevated blood glucose, transient creatinine abnormalities) were resolved with symptomatic management. Patient experienced a confirmed partial response after follow-up for at least 5&#xa0;years.</p> Conclusion <p>This case demonstrates unprecedented long-term survival in a patient with KRAS p.Q61H/TP53 c.G738A-mutant lung adenocarcinoma and brain metastasis treated with pemetrexed-based maintenance therapy combined with local interventions. The regimen showed efficacy, safety, and cost-effectiveness, offering a viable strategy for resource-limited settings.</p>

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Novel strategy of pemetrexed combined with localized therapy: breakthrough impact of long-term maintenance regimen on patient survival—a case report

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年5月13日

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  • Dan Liu,
  • Xiaobiao Ma,
  • Chunlei Ge,
  • Qian Huang,
  • Yiqing Duan,
  • Li Li

摘要

Background

The outcomes of untreated patients with lung adenocarcinoma with brain metastasis are poor; the usual survival period was around weeks to 3 months. While molecularly targeted agents and immune checkpoint inhibitors demonstrate survival benefits in selected populations, significant access barriers persist, particularly among socioeconomically disadvantaged groups. This report details exceptional survival duration in a KRAS p.Q61H/TP53 co-mutant case, exceeding conventional survival estimates and necessitating strategies to overcome system-level care constraints.

Case presentation

A male Asian patient aged 70–80 years presented with bilateral pulmonary lobe lesions (largest: 57 mm in left inferior lobe) and a 14-mm right frontal lobe metastasis. Histopathological and immunohistochemical analysis confirmed stage IV pulmonary adenocarcinoma, with genomic testing revealing co-mutations in KRAS exon 3 c.183A > C (p.Q61H) and TP53 exon 7 c.738G > A (p.R247K). The patient received pemetrexed–cisplatin chemotherapy, radiotherapy, and palliative surgery. Mild adverse events (drug eruption, elevated blood glucose, transient creatinine abnormalities) were resolved with symptomatic management. Patient experienced a confirmed partial response after follow-up for at least 5 years.

Conclusion

This case demonstrates unprecedented long-term survival in a patient with KRAS p.Q61H/TP53 c.G738A-mutant lung adenocarcinoma and brain metastasis treated with pemetrexed-based maintenance therapy combined with local interventions. The regimen showed efficacy, safety, and cost-effectiveness, offering a viable strategy for resource-limited settings.