Fig. 2.

Treatment course after the appearance of lung metastases by CT evaluation. (a) Findings before the start of treatment. Multiple lung metastases and local recurrence are observed (eGFR = 75.7ml/min/1.73m²). (b) Findings after two courses of first GC. Multiple lung metastases did not change significantly, but local recurrence progressed. As shown by the yellow arrow, the left hydroureter was newly confirmed (eGFR = 65.4ml/min/1.73m²). (c) Findings after four courses of pembrolizumab. Multiple lung metastases were markedly increased (eGFR = 69.7ml/min/1.73m²). (d) Findings after one course of re‐challenge GC. Multiple lung metastases were significantly reduced, while local recurrence was unchanged (eGFR = 73.6ml/min/1.73m²). (e) Findings after three courses of re‐challenge GC. Multiple lung metastases were further reduced (eGFR = 73.3ml/min/1.73m²).