PRaG 3.0 therapy for human epidermal growth factor receptor 2-positive metastatic pancreatic ductal adenocarcinoma: A case report

Figure 1 Treatment schedule of the PRaG3. 0 therapy and treatment efficacy evaluation of the patient. A: Hematoxylin and eosin staining and immunohistochemistry assay for CK19, human epidermal growth factor receptor 2 (HER-2), Hepar1, MLH1, MSH2, MSH6 and PMS2 of liver lesions. CK19 was expressed in tumor cells but Hepar1 was not expressed. HER-2 was weakly expressed in tumor cell membranes. MLH1, MSH2, MSH6 and PMS2 were expressed in tumors indicating mismatch repair proficient; B: Treatment schedule of the PRaG3.0 therapy. The patient received two activation cycle and six maintenance cycle. The time of positron emission tomography-computed tomography (PET-CT) was also indicated; C: Serum carbohydrate antigen 19-9 (Ca 19-9), Ca 50 and Ca 242 levels of the patient during the treatment; D: Peripheral cytokines [interleukin (IL)-2, IL-4, IL-6, IL-10, IL-17A, tumor necrosis factor and interferon-γ] levels changes of the patient during the treatment. E: The PET-CT evaluation of the patient at baseline and after cycle 2, 4, 7 and 8. ADC: Antibody-drug conjugate; Ca: Carbohydrate antigen; GM-CSF: Granulocyte-macrophage colony-stimulating factor; HE: Hematoxylin and eosin; HER-2: Human epidermal growth factor receptor 2; IFN: Interferon; IL: Interleukin; SBRT: Stereotactic body radiotherapy; TNF: Tumor necrosis factor.

Figure 2 The percentage and absolute numbers of lymphocyte subsets at baseline and after each cycle. A: The percentage of peripheral lymphocytes, including CD4⁺Temra, CD8⁺Temra, activated CD4⁺Temra, activated CD8⁺Temra, activated CD4⁺Tem, activated CD8⁺Tem and Tregs at baseline and after each cycle; B and C: Absolute numbers of peripheral lymphocytes subsets at baseline and after each cycle.