{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,15]],"date-time":"2025-08-15T00:17:56Z","timestamp":1755217076815,"version":"3.43.0"},"reference-count":28,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,8,5]],"date-time":"2025-08-05T00:00:00Z","timestamp":1754352000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Immunol."],"abstract":"<jats:p>This case report presents a rare instance of synchronous multiple primary cancers involving lung adenocarcinoma with bone metastasis, gastric signet-ring cell carcinoma, and rectal cancer. The 64-year-old male patient was treated with a combination of sintilimab, chemotherapy, and targeted therapy. Following a multidisciplinary team consultation, systemic treatment with sintilimab, oxaliplatin, and capecitabine was initiated concurrently while furmonertinib targeted therapy continued. After six cycles, the lung lesions showed significant reduction, while the gastric and intestinal tumors remained stable. The patient transitioned to maintenance therapy and achieved sustained disease control without severe adverse effects. This case highlights the potential of an integrated immunotherapy and chemotherapy approach for treating multiple primary malignancies with distinct pathological origins. report also underscores the need for individualized, biomarker-driven treatment strategies and further research on optimal therapeutic combinations for synchronous multiple primary cancers.<\/jats:p>","DOI":"10.3389\/fimmu.2025.1614911","type":"journal-article","created":{"date-parts":[[2025,8,5]],"date-time":"2025-08-05T05:25:40Z","timestamp":1754371540000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Case Report: Successful treatment of triple primary cancers (lung, stomach, and intestine) using sintilimab combined with chemotherapy and targeted therapy"],"prefix":"10.3389","volume":"16","author":[{"given":"Qi-Qing","family":"Zhang","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xin-Xin","family":"Luo","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hua","family":"Chen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wei","family":"Wang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yi-Fan","family":"Xie","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hong-Li","family":"Qiao","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hao-Jun","family":"Miao","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zheng-Quan","family":"Feng","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2025,8,5]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.12998\/wjcc.v12.i15.2649","article-title":"Cetuximab combined with chemotherapy for simultaneous esophageal squamous cell carcinoma and colon adenocarcinoma: A case report","volume":"12","author":"Luo","year":"2024","journal-title":"World J Clin Cases"},{"volume-title":"SEER program coding and staging manual 2014","year":"2014","author":"Adamo","key":"B2"},{"key":"B3","article-title":"International rules for multiple primary cancers","volume":"6","year":"2005","journal-title":"Asian Pac J Cancer Prev"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1097\/00008469-200508000-00002","article-title":"International rules for multiple primary cancers (ICD-0 third edition)","volume":"14","year":"2005","journal-title":"Eur J Cancer Prev"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1136\/esmoopen-2017-000172","article-title":"Multiple primary tumors: challenges and approaches, a review","volume":"2","author":"Vogt","year":"2017","journal-title":"ESMO Open"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.4251\/wjgo.v15.i12.2049","article-title":"Dual primary gastric and colorectal cancer: a complex challenge in surgical oncology","volume":"15","author":"Marano","year":"2023","journal-title":"World J Gastrointest Oncol"},{"volume-title":"Chinese Society of Clinical Oncology (CSCO) lung cancer diagnosis and treatment guidelines 2021","year":"2021","key":"B7"},{"volume-title":"Chinese Society of Clinical Oncology (CSCO) lung cancer diagnosis and treatment guidelines 2024","year":"2024","key":"B8"},{"volume-title":"Chinese Society of Clinical Oncology (CSCO) gastric cancer diagnosis and treatment guidelines 2024","year":"2024","key":"B9"},{"volume-title":"Chinese Society of Clinical Oncology (CSCO) rectal cancer diagnosis and treatment guidelines 2024","year":"2024","key":"B10"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.1001\/jamaoncol.2017.0278","article-title":"FOLFOXIRI plus bevacizumab as conversion therapy for patients with initially unresectable metastatic colorectal cancer: a systematic review and pooled analysis","volume":"3","author":"Tomasello","year":"2017","journal-title":"JAMA Oncol"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.1158\/0008-5472.CAN-14-3362","article-title":"Control of PD-L1 expression by oncogenic activation of the AKT-mTOR pathway in non-small cell lung cancer","volume":"76","author":"Lastwika","year":"2016","journal-title":"Cancer Res"},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.1002\/ijc.32140","article-title":"Functional loss of ARID1A is tightly associated with high PD-L1 expression in gastric cancer","volume":"145","author":"Kim","year":"2019","journal-title":"Int J Cancer"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.1080\/2162402X.2021.1956173","article-title":"Association of PIK3CA mutation and PTEN loss with expression of CD274 (PD-L1) in colorectal carcinoma","volume":"10","author":"Ugai","year":"2021","journal-title":"Oncoimmunology"},{"key":"B15","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2024.1453176","article-title":"Mid-term follow-up results of neoadjuvant sintilimab combined with chemotherapy for locally advanced resectable esophageal squamous cell carcinoma","volume":"15","author":"Cai","year":"2024","journal-title":"Front Immunol"},{"key":"B16","doi-asserted-by":"publisher","DOI":"10.1016\/j.semcancer.2019.07.009","article-title":"PI3K\/Akt\/mTOR inhibitors in cancer: at the bench and bedside","volume":"59","author":"Alzahrani","year":"2019","journal-title":"Semin Cancer Biol"},{"key":"B17","doi-asserted-by":"publisher","first-page":"290","DOI":"10.1016\/j.ebiom.2022.104194","article-title":"PTGER3 induces ovary tumorigenesis and confers resistance to cisplatin therapy through up-regulation Ras-MAPK\/Erk-ETS1-ELK1\/CFTR1 axis","volume":"40","author":"Rodriguez-Aguayo","year":"2019","journal-title":"EBioMedicine"},{"key":"B18","doi-asserted-by":"publisher","first-page":"77","DOI":"10.1097\/BS9.0000000000000149","article-title":"PD-L1: expression regulation","volume":"5","author":"Zhou","year":"2023","journal-title":"Blood Sci"},{"key":"B19","doi-asserted-by":"publisher","DOI":"10.1016\/j.annonc.2022.12.009","article-title":"Oncogene-addicted metastatic non-small-cell lung cancer: ESMO Clinical Practice Guideline for diagnosis, treatment and follow-up","volume":"34","author":"Hendriks","year":"2023","journal-title":"Ann Oncol"},{"key":"B20","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtho.2020.09.015","article-title":"Long-term overall survival from KEYNOTE-021 cohort G: pemetrexed and carboplatin with or without pembrolizumab as first-line therapy for advanced nonsquamous NSCLC","volume":"16","author":"Awad","year":"2021","journal-title":"J Thorac Oncol"},{"key":"B21","doi-asserted-by":"publisher","DOI":"10.1080\/19420862.2019.1654303","article-title":"Durable blockade of PD-1 signaling links preclinical efficacy of sintilimab to its clinical benefit","volume":"11","author":"Wang","year":"2019","journal-title":"MAbs"},{"key":"B22","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2023.19918","article-title":"Sintilimab plus chemotherapy for unresectable gastric or gastroesophageal junction cancer: the ORIENT-16 randomized clinical trial","volume":"330","author":"Xu","year":"2023","journal-title":"JAMA"},{"volume-title":"Chinese Society of Clinical Oncology (CSCO) gastric cancer diagnosis and treatment guidelines 2023","year":"2023","key":"B23"},{"key":"B24","doi-asserted-by":"publisher","first-page":"27","DOI":"10.1016\/S0140-6736(21)00797-2","article-title":"First-line nivolumab plus chemotherapy versus chemotherapy alone for advanced gastric, gastro-esophageal junction, and esophageal adenocarcinoma (CheckMate 649): a randomized, open-label, phase 3 trial","volume":"398","author":"Janjigian","year":"2021","journal-title":"Lancet"},{"key":"B25","doi-asserted-by":"publisher","DOI":"10.1001\/jamaoncol.2020.3370","article-title":"Efficacy and safety of pembrolizumab or pembrolizumab plus chemotherapy vs chemotherapy alone for patients with first-line, advanced gastric cancer: the KEYNOTE-062 phase 3 randomized clinical trial","volume":"6","author":"Shitara","year":"2020","journal-title":"JAMA Oncol"},{"key":"B26","doi-asserted-by":"publisher","first-page":"S1192","DOI":"10.1016\/j.annonc.2020.08.2297","article-title":"Nivolumab plus chemotherapy versus chemotherapy alone in patients with previously untreated advanced or recurrent gastric\/gastroesophageal junction (G\/GEJ) cancer: ATTRACTION-4 (ONO-4538-37) study","volume":"31","author":"Boku","year":"2020","journal-title":"Ann Oncol"},{"key":"B27","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2201445","article-title":"PD-1 blockade in mismatch repair-deficient, locally advanced rectal cancer","volume":"386","author":"Cercek","year":"2022","journal-title":"N Engl J Med"},{"key":"B28","doi-asserted-by":"publisher","first-page":"1570","DOI":"10.1016\/j.ccell.2024.07.004","article-title":"Effect of neoadjuvant chemoradiotherapy with or without PD-1 antibody sintilimab in pMMR locally advanced rectal cancer: a randomized clinical trial","volume":"42","author":"Xiao","year":"2024","journal-title":"Cancer Cell"}],"container-title":["Frontiers in Immunology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fimmu.2025.1614911\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,5]],"date-time":"2025-08-05T05:25:43Z","timestamp":1754371543000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fimmu.2025.1614911\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8,5]]},"references-count":28,"alternative-id":["10.3389\/fimmu.2025.1614911"],"URL":"https:\/\/doi.org\/10.3389\/fimmu.2025.1614911","relation":{},"ISSN":["1664-3224"],"issn-type":[{"type":"electronic","value":"1664-3224"}],"subject":[],"published":{"date-parts":[[2025,8,5]]},"article-number":"1614911"}}