{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T19:33:40Z","timestamp":1791228820587,"version":"4.1.0"},"reference-count":33,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,12,1]],"date-time":"2025-12-01T00:00:00Z","timestamp":1764547200000},"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:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Pancreatic neuroendocrine carcinoma (pNEC) is a rare and aggressive malignancy. For patients with metastatic pNEC, the response to first-line chemotherapy remains unfavorable, with a median overall survival of less than one year. Furthermore, there are no standard-of-care therapeutic options following disease progression, representing a significant unmet clinical need.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case presentation<\/jats:title>\n                    <jats:p>This is a case report of a patient diagnosed with metastatic pNEC presenting with upper abdominal pain, testing 80% positive for the Ki67 marker, a combined positive score (CPS) of 0, and proficient mismatch repair (pMMR). Following progression after chemotherapy, the patient received combination immunotherapy, involving multi-site, multi-dose, and multi-type radiotherapies combined with programmed death 1 (PD-1), accompanied by continuous probiotic supplementation. Imaging examination revealed that the tumor completely disappeared, and the patient maintained a no-evidence-of-disease (NED) status for over seven years.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This case demonstrates that multi-site, multi-dose, and multi-type radiotherapies can more effectively reveal the heterogeneous tumor antigens, and the combined therapy of immunotherapy and probiotics may achieve sustained immune responses.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fimmu.2025.1682148","type":"journal-article","created":{"date-parts":[[2025,12,1]],"date-time":"2025-12-01T06:26:12Z","timestamp":1764570372000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":3,"title":["A case report of advanced pancreatic neuroendocrine carcinoma with Ki67 80%, CPS 0, and pMMR achieving durable complete 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