RATIONALE: The targeting of signal transduction through programmed cell death 
receptor-1 (PD-1) and its ligand programmed cell death-ligand 1 (PD-L1) in 
patients with non-small cell lung cancer (NSCLC) has been widely applied in 
clinical research. However, the subtypes and treatment patterns that predict 
responses to PD-1/PD-L1 inhibitors are not fully understood. Biomarkers, such as 
PD-L1 expression, tumor mutation load, and DNA mismatch repair defects, have 
been used to screen patients who respond to PD-1/PD-L1 inhibitors, but the 
appropriate treatment mode requires further investigation. Immune checkpoint 
inhibitors combined with radiotherapy provide benefits from remote effects, 
especially in NSCLC patients with increased PD-L1 expression.
PATIENT CONCERNS: We report a 64-year-old man who presented with left back pain 
for 40 days. A computed tomography scan showed a mass in the right upper lobe of 
the lung, with metastases in the right hilar and mediastinal lymph nodes.
DIAGNOSIS: NSCLC-not otherwise specified was diagnosed by computed 
tomography-guided lung biopsy.
INTERVENTIONS: After the failure of first-line chemotherapy, next-generation 
sequencing was performed for comprehensive gene analysis, and PD-L1 expression 
levels were evaluated by immunohistochemistry. The patient was treated with 
toripalimab (a PD-1 inhibitor) concurrently with radiotherapy for bone 
metastases.
OUTCOMES: The detection results showed a high tumor mutation burden and 
increased PD-L1 expression. On the basis of these findings, the patient received 
toripalimab (PD-1 inhibitor) combined with radiotherapy for bone metastases. 
Partial response was achieved after 3 cycles, and the patient showed stable 
disease at the end of the sixth and ninth cycles of toripalimab. The patient was 
followed up for 26 months. At present, the patient is receiving toripalimab 
maintenance treatment, which has been well-tolerated without adverse events.
LESSON: Toripalimab combined with radiotherapy may exert a synergistic 
anti-tumor effect through remote effects in advanced or metastatic NSCLC with 
high PD-L1 expression. However, the specific treatment mode requires further 
confirmation by the investigation of additional cases.