ArticleJournal of medical case reports2026
Novel strategy of pemetrexed combined with localized therapy: breakthrough impact of long-term maintenance regimen on patient survival-a case report.
Article in Journal of medical case reports, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundThe 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.
conclusionThis 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.
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