My name is Zhang Liang (a pseudonym), a post-80s who was diagnosed with cancer when I was just in my early 30s. I visited the hospital in January 2017 for chest and back pain. The bronchoscopic biopsy tissue was subjected to pathological examination and tumor gene detection by YuceBio. The pathological findings confirmed stage IV lung adenocarcinoma of T4N2M1b; the gene detection result revealed EGFR exon 19 deletion mutation. There is a silver lining for me that, at least, I could receive targeted drugs.

In February 2017, I started my battle against cancer and was treated with the EGFR-TKI, icotinib. Unfortunately, I developed acquired resistance after 5 months and gene detection showed an EGFR T790M mutation. There was no choice but to go back on chemotherapy, pemetrexed plus nedaplatin for 4 cycles and pemetrexed for 1 more cycle, until the disease progressed in November 2017. I was really desperate by that time. I could tolerate the side effects of the treatment, and luckily I had insurance to cover the treatment costs. But I had just built a family and my child was only over 1 year old. I wanted to raise him up and I couldn't stand the idea of my parents watching me die. After a year of treatment and 2 different regimens, the disease still persisted and progressed. I felt hopeless. But I had to keep looking for treatment solutions and to keep living.

Opdivo (Nivolumab) was already available in Japan and the US in 2014, but was not marketed in China until 2018. In early 2018 my primary care physician (PCP) asked me whether I would like to participate in a Phase III clinical trial (NCT03195491) of Nivolumab monotherapy, which enrolled patients with advanced NSCLC who had failed prior systemic therapy. I also did a lot of research on the subject and learned that this drug had shown good results in previous clinical trials, so I decided to join. The doctor then arranged tumor gene detection for me at YuceBio, which was needed to determine if I was eligible for enrollment. Yuce performed whole exome sequencing (WES), transcriptome sequencing (RNA-seq), and PD-L1 immunohistochemical assays on tumor tissues. Results for the tumor tissues showed moderate tumor mutation burden (TMB = 6.00 muts/Mb), moderate tumor neoantigen burden (TNB = 2.67 neos/Mb), high PD-L1 expression (TPS ≥ 50%), and no immunotherapy-related negative indicators other than EGFR mutations were detected. The PCP said that I was eligible for enrollment. Our family was so happy to hear it and saw a glimmer of hope again.

I started nivolumab treatment in June 2018 and during that time I experienced a slight malaise but generally tolerated it well. CT test was performed anew in September 2018 and showed partial response (PR) with tumor regression in lung and brain metastases. Subsequently, I received 240 mg of nivolumab intravenously every fortnight and my condition is now stable according to routine CT/MRI checks.

It has been 4 years since my diagnosis and I hope that next year I would continue to share my experience of fighting cancer.