# Case Report: Multimodal immunotherapeutic regimen (envafolimab + chemotherapy + radiotherapy) for four synchronous primary malignant neoplasms: a case report of 33-month survival and implications for tumor immunology

## TL;DR

A patient with four simultaneous cancers survived 33 months using a combination of immunotherapy, chemotherapy, and radiotherapy, offering insights into treating complex cancer cases.

## Contribution

This case report highlights the potential of multimodal immunotherapy in treating multiple primary malignancies and its implications for tumor immunology.

## Key findings

- A patient with four synchronous cancers achieved 33-month survival using envafolimab, chemotherapy, and radiotherapy.
- The case suggests that multimodal immunotherapy may offer clinical benefits for complex cancer cases.
- The report discusses mechanisms and challenges of immunotherapy in treating multiple primary malignancies.

## Abstract

Multiple Primary Malignant Neoplasms (MPMNs) are defined as the presence of two or more independent malignant tumors in the same patient, either simultaneously or sequentially, presenting substantial diagnostic and therapeutic challenges. In recent years, immunotherapy—an emerging therapeutic modality—has shown notable clinical efficacy across a range of malignancies. This article reports a case of a patient with four concurrent primary malignancies who attained long-term survival following treatment with envafolimab injection. Using this case as a foundation, we discuss recent advances in immunotherapy for MPMNs, covering its mechanisms of action, clinical efficacy, therapeutic strategies, and current challenges. The goal is to provide a theoretical basis for clinical practice and identify future research directions.