However, the effects of long-term ICI treatment remain insufficient and the development of resistance is an issue that remains to be solved.<h4>Case presentation</h4>A 70-year-old man was diagnosed with lung adenocarcinoma (stage IVB, T4N3M1c) with a high programmed death ligand-1 (PDL1) expression level (tumor proportion score [TPS]: 80% score at the time of the diagnosis, before treatment). The gene discussed is CD274; the disease is neoplasm.