pemetrexed

Sequential adrenal resection revealed divergent squamous differentiation (p40+/CK5/6+; TTF-1-/Napsin-A-) with KRAS/MYC and NF-1 amplification, supporting a final diagnosis of pulmonary adenosquamous carcinoma-an aggressive NSCLC variant comprising 0.4-4% of lung malignancies.Management and OutcomeTreatment followed evidence-based, histology-guided sequencing: concurrent carboplatin-pemetrexed chemoradiation, nivolumab upon platinum resistance, and cytotoxic salvage with docetaxel followed by vinorelbine. The patient survived 42 months from diagnosis, the clinical course was shaped by adequate tissue sampling, diagnostic challenges, and multidisciplinary histology-guided treatment acquisition.ConclusionThis case underscores the diagnostic and therapeutic complexity of lung adenocarcinoma presenting with synchronous colonic metastases without a discrete parenchymal mass, compounded by intratumoral heterogeneity and phenotypic divergence across metastases. Comprehensive tissue sampling enabling serial immunohistochemical and molecular characterization, coupled with coordinated multidisciplinary management, is essential to optimize diagnostic accuracy and therapeutic sequencing in this rare and clinically challenging disease entity.

P1, N=157, Completed, BeiGene | Active, not recruiting --> Completed

P3, N=570, Not yet recruiting, CSPC Megalith Biopharmaceutical Co.,Ltd.

Clinical courses were heterogeneous: one patient achieved a durable partial response using combined osimertinib and crizotinib. A second patient, intolerant to dual TKI therapy due to QTc prolongation and grade 3 edemas, achieved a sustained partial response with platinum-pemetrexed chemotherapy...However, its biological significance, driver versus passenger role, and therapeutic relevance remain uncertain. Combined EGFR and ROS1 inhibition may be considered in selected cases, but further validation is required.

P2/3, N=30, Recruiting, Second Affiliated Hospital of Nanchang University | Trial completion date: Apr 2026 --> Dec 2028 | Trial primary completion date: Apr 2026 --> Oct 2028

Serial CSF sampling also captured treatment-associated molecular shifts, including progressive TYMS amplification during intrathecal pemetrexed in an exploratory case. Together, these findings support low-input CSF sequencing as a practical molecular approach to complement LM diagnosis and longitudinal monitoring in lung cancer and provide a rationale for prospective validation in independent multi-center cohorts.

Initial therapy with 'pemetrexed + carboplatin + tislelizumab' was administered...The RA flare was managed with methylprednisolone 1 mg/kg/day followed by a slow prednisone taper and sulfasalazine. Treatment was switched to 'pemetrexed + carboplatin + bevacizumab'...It may create a potential opportunity for conversion surgery in well-responding patients, enabling long-term disease control. This case underscores the critical importance of highly individualized, multidisciplinary treatment decision-making.

P3, N=583, Completed, Incyte Corporation | Trial completion date: Aug 2026 --> May 2026 | Active, not recruiting --> Completed

P3, N=1170, Active, not recruiting, Daiichi Sankyo | Trial completion date: May 2029 --> May 2031

P2/3, N=410, Recruiting, Sinocelltech Ltd.

P2, N=90, Active, not recruiting, Mirati Therapeutics Inc. | Recruiting --> Active, not recruiting | Trial primary completion date: Jun 2026 --> Sep 2026

This study estimated the cost-effectiveness of sacituzumab tirumotecan (Sac-TMT) versus pemetrexed-platinum chemotherapy as second-line therapy for advanced EGFR-mutated non-small cell lung cancer (NSCLC) in China. A price reduction exceeding 73.81% would bring the ICER below the WTP threshold. At current prices, Sac-TMT is not cost-effective as second-line therapy for advanced EGFR-mutated NSCLC in China.