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Zeng J, Ding X, Ding J, Wang X. Histological transformation into SCLC: An important resistance mechanism of NSCLC upon immunotherapy. Front Immunol 2023; 14:1275957. [PMID: 38022621 PMCID: PMC10646212 DOI: 10.3389/fimmu.2023.1275957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 10/16/2023] [Indexed: 12/01/2023] Open
Abstract
The phenomenon of histological transformation has been widely reported in advanced non-small cell lung cancer (NSCLC) with EGFR mutations following the failure of EGFR-TKI treatment. Recent evidence suggests that similar histological changes can also occur in advanced NSCLC without driver gene mutations after developing resistance to immunotherapy. In this review, it was found that 66.7% of cases with immunotherapy-induced histological transformation were classified as lung squamous cell carcinoma (LSCC), while histological conversion into lung adenocarcinoma (LUAD) without EGFR or ALK gene mutations has rarely been reported. There have been sporadic reports on the occurrence of mutual transformation between LUAD and LSCC. The histological conversion from NSCLC into small cell lung cancer (SCLC) appears to be significantly underestimated, likely due to the infrequency of re-biopsy following the development of immunotherapy resistance. Several studies have reported a close association between the transformation and mutations at TP53 and the RB1 splice site, as well as the loss of an FBXW7 mutation. However, the exact mechanisms underlying this conversion remain unclear. Currently, there is a lack of guidelines for the management of transformed SCLC from NSCLC following immunotherapy, with chemotherapy being the most commonly employed treatment approach.
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Affiliation(s)
- Jiao Zeng
- Department of Hematology & Oncology, Jiujiang University Affiliated Hospital, Jiujiang, Jiangxi, China
- Graduate Department, Gannan Medical University, Ganzhou, Jiangxi, China
| | - Xinjing Ding
- Department of Oncology, First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Jianghua Ding
- Department of Hematology & Oncology, Jiujiang University Affiliated Hospital, Jiujiang, Jiangxi, China
| | - Xin Wang
- Department of Social Medicine and Public Health, School of Basic Medicine, Jiujiang University, Jiujiang, Jiangxi, China
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Zhang H, Ren D, Cheng D, Wang W, Li Y, Wang Y, Lu D, Zhao F. Construction of a mortality risk prediction model for elderly people at risk of lobectomy for NSCLC. Front Surg 2023; 9:1055338. [PMID: 36684251 PMCID: PMC9853536 DOI: 10.3389/fsurg.2022.1055338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 12/13/2022] [Indexed: 01/07/2023] Open
Abstract
Background An increasing number of lung cancer patients are opting for lobectomy for oncological treatment. However, due to the unique organismal condition of elderly patients, their short-term postoperative mortality is significantly higher than that of non-elderly patients. Therefore, there is a need to develop a personalised predictive tool to assess the risk of postoperative mortality in elderly patients. Methods Information on the diagnosis and survival of 35,411 older patients with confirmed lobectomy NSCLC from 2009 to 2019 was screened from the SEER database. The surgical group was divided into a high-risk mortality population group (≤90 days) and a non-high-risk mortality population group using a 90-day criterion. Survival curves were plotted using the Kaplan-Meier method to compare the differences in overall survival (OS) and lung cancer-specific survival (LCSS) between the two groups. The data set was split into modelling and validation groups in a ratio of 7.5:2.5, and model risk predictors of postoperative death in elderly patients with NSCLC were screened using univariate and multifactorial logistic regression. Columnar plots were constructed for model visualisation, and the area under the subject operating characteristic curve (AUC), DCA decision curve and clinical impact curve were used to assess model predictiveness and clinical utility. Results Multi-factor logistic regression results showed that sex, age, race, histology and grade were independent predictors of the risk of postoperative death in elderly patients with NSCLC. The above factors were imported into R software to construct a line graph model for predicting the risk of postoperative death in elderly patients with NSCLC. The AUCs of the modelling and validation groups were 0.711 and 0.713 respectively, indicating that the model performed well in terms of predictive performance. The DCA decision curve and clinical impact curve showed that the model had a high net clinical benefit and was of clinical application. Conclusion The construction and validation of a predictive model for death within 90 days of lobectomy in elderly patients with lung cancer will help the clinic to identify high-risk groups and give timely intervention or adjust treatment decisions.
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Affiliation(s)
- Hongzhen Zhang
- Shanghai Fengxian District Central Hospital, Affiliated to Anhui University of Science and Technology, Fengxian, China
| | - Dingfei Ren
- Occupational Control Hospital of Huai He Energy Group, Huainan, China
| | - Danqing Cheng
- Graduate School of Bengbu Medical College, Bengbu, China
| | - Wenping Wang
- Graduate School of Bengbu Medical College, Bengbu, China
| | - Yongtian Li
- Anhui University of Science and Technology College of Medicine, Huainan, China
| | - Yisong Wang
- Anhui University of Science and Technology College of Medicine, Huainan, China
| | - Dekun Lu
- The First Hospital of Anhui University of Science & Technology (Huai nan First People's Hospital), Huainan, China
| | - Feng Zhao
- The First Hospital of Anhui University of Science & Technology (Huai nan First People's Hospital), Huainan, China,Correspondence: Feng Zhao
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Sato Y, Saito G, Fujimoto D. Histologic transformation in lung cancer: when one door shuts, another opens. Ther Adv Med Oncol 2022; 14:17588359221130503. [PMID: 36268218 PMCID: PMC9577078 DOI: 10.1177/17588359221130503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 09/12/2022] [Indexed: 11/05/2022] Open
Abstract
Histologic transformation (HT) is a major cause of drug resistance to therapy in
patients with lung cancer. HTs to small-cell lung cancer (SCLC) have been
reported frequently in patients with epidermal growth factor receptor
(EGFR)-mutated lung cancer. Although HTs have an impact on
the clinical outcomes in patients owing to a high refractoriness to treatments,
there is limited data on the prevalence, causes, mechanisms, treatment efficacy,
and future treatment strategies. In this review, we assess the literature
regarding HTs comprehensively, including those describing EGFR-tyrosine kinase
inhibitors, other molecular targeted drugs, and immune checkpoint inhibitors.
Furthermore, we discuss the mechanisms of HTs and the lineage plasticity to SCLC
and squamous cell carcinoma in lung cancer. In addition, we summarize the
treatment efficacy and future perspectives of HTs in patients with lung cancer,
and propose better management strategies for this group of patients.
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Mariniello A, Righi L, Morrone A, Carnio S, Bironzo P. Squamous cell histological transformation in a lung adenocarcinoma patient (hyper) progressing upon immunotherapy. TUMORI JOURNAL 2022; 108:NP15-NP19. [PMID: 35277092 DOI: 10.1177/03008916221080487] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION In non-small cell lung cancer (NSCLC) histologic transformation upon immune checkpoint inhibitors (ICI) is rare. CASE PRESENTATION We described the case of a patient with early-stage lung adenocarcinoma who relapsed after surgery. At the time of relapse, he received chemo-radiotherapy, followed by consolidation immunotherapy. After 3 cycles the patient experienced disease hyperprogression for onset of a new lung mass, which resulted in squamous cell carcinoma. The preservation of an atypical mutation in the v-raf murine sarcoma viral oncogene homolog B1 (BRAF) gene in both the primary adenocarcinoma and the new squamous carcinoma suggests histological transformation, likely ICI-related. DISCUSSION We reviewed similar cases in literature, highlighting common patterns and substantial differences. For a deeper insight into inherent biological mechanisms, re-biopsy in case of atypical ICI response should be encouraged.
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Affiliation(s)
- Annapaola Mariniello
- Division of Thoracic Oncology, Department of Oncology, University of Torino at San Luigi Gonzaga University Hospital, Orbassano, Italy
| | - Luisella Righi
- Division of Pathology, Department of Oncology, University of Torino at San Luigi Gonzaga University Hospital, Orbassano, Italy
| | - Antonio Morrone
- Division of Pathology, Department of Oncology, University of Torino at San Luigi Gonzaga University Hospital, Orbassano, Italy
| | - Simona Carnio
- Division of Thoracic Oncology, Department of Oncology, University of Torino at San Luigi Gonzaga University Hospital, Orbassano, Italy
| | - Paolo Bironzo
- Division of Thoracic Oncology, Department of Oncology, University of Torino at San Luigi Gonzaga University Hospital, Orbassano, Italy
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Clamon G, Zeitler W, An J, Hejleh TA. Transformational Changes Between Non-Small Cell and Small Cell Lung Cancer-Biological and Clinical Relevance-A Review. Am J Clin Oncol 2020; 43:670-675. [PMID: 32889839 DOI: 10.1097/coc.0000000000000720] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
During the course of therapy, patients with small cell lung cancer have been noted to develop transformation to non-small cell lung cancer and conversely, patients with non-small cell lung cancer have had transformation to small cell lung cancer or other non-small cell histologies. Transformation may occur after prior tyrosine kinase inhibitors, chemotherapy, immunotherapy or radiation therapy. These changes reflect on the overlapping biology of these cell types and the clinical need for re-biopsy at times of disease progression. The optimum therapy after transformation will depend upon prior therapies received, the functional capacity of the patient, and further research to define the best therapy options.
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Affiliation(s)
- Gerald Clamon
- Department of Internal Medicine, Division of Hematology, Oncology, Blood and Marrow Transplantation, University of Iowa Hospitals and Clinics, Iowa City, IA
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Hasegawa M, Hasegawa G, Ikeda Y, Hara N, Nishiyama T. Emergence of undifferentiated urothelial carcinoma after pembrolizumab treatment for patient with invasive urothelial bladder cancer: A case report. SAGE Open Med Case Rep 2020; 8:2050313X20932694. [PMID: 32587697 PMCID: PMC7294485 DOI: 10.1177/2050313x20932694] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 05/17/2020] [Indexed: 11/17/2022] Open
Abstract
An 83-year-old man received pembrolizumab treatment after anticancer chemotherapy with gemcitabine and cisplatin for advanced bladder cancer. Pathological findings revealed invasive urothelial carcinoma with squamous differentiation before treatment. After seven courses of pembrolizumab treatment, the tumor disappeared. After 15 courses of the treatment, the tumor regrew. Pathological findings revealed invasive undifferentiated urothelial carcinoma consisting of relatively small tumor cells of the same size as lymphocytes, negative for neuroendocrine markers. Programmed death-ligand 1 expressions in tumor tissue changed from positive before treatment to negative after pembrolizumab treatment.
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Affiliation(s)
- Moto Hasegawa
- Department of Urology, Uonuma Institute of Community Medicine, Niigata University Medical and Dental Hospital, Niigata, Japan
| | - Go Hasegawa
- Department of Pathology, Uonuma Institute of Community Medicine, Niigata University Medical and Dental Hospital, Niigata, Japan
| | - Yohei Ikeda
- Department of Diagnostic Radiology, Uonuma Institute of Community Medicine, Niigata University Medical and Dental Hospital, Niigata, Japan
| | - Noboru Hara
- Department of Urology, Uonuma Institute of Community Medicine, Niigata University Medical and Dental Hospital, Niigata, Japan
| | - Tsutomu Nishiyama
- Department of Urology, Uonuma Institute of Community Medicine, Niigata University Medical and Dental Hospital, Niigata, Japan
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Si X, You Y, Zhang X, Wang H, Wang M, Zhang L. Histologic transformation of lung cancer during pembrolizumab therapy: A case report. Thorac Cancer 2020; 11:793-796. [PMID: 31944570 PMCID: PMC7049493 DOI: 10.1111/1759-7714.13312] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 12/25/2019] [Accepted: 12/27/2019] [Indexed: 11/28/2022] Open
Abstract
Immune checkpoint inhibitors that block the programmed death 1/programmed death ligand 1 pathways are widely used to treat advanced lung cancers. There are seldom cases of histologic transformation reported after treatment with immunotherapy. Here, we report the case of a 69‐year‐old man with stage IV lung squamous cell carcinoma. He received pembrolizumab monotherapy and had a partial response. After 22 cycles of pembrolizumab, chest computed tomography (CT) showed a left hilar tumor, bilateral pleural effusion and lymphadenopathy. The cytology of pleural effusion and bronchoscopic biopsy of an intraluminal lesion revealed small cell lung cancer. After two cycles of chemotherapy (etoposide/carboplatin), CT scan revealed shrinkage of lesions. This is the first case of lung squamous cell carcinoma with histologic transformation after treatment with pembrolizumab alone.
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Affiliation(s)
- Xiaoyan Si
- Division of Pulmonary and Critical Care Medicine, Peking Union Medical College Hospital, Beijing, China
| | - Yan You
- Department of Pathology, Peking Union Medical College Hospital, Beijing, China
| | - Xiaotong Zhang
- Division of Pulmonary and Critical Care Medicine, Peking Union Medical College Hospital, Beijing, China
| | - Hanping Wang
- Division of Pulmonary and Critical Care Medicine, Peking Union Medical College Hospital, Beijing, China
| | - Mengzhao Wang
- Division of Pulmonary and Critical Care Medicine, Peking Union Medical College Hospital, Beijing, China
| | - Li Zhang
- Division of Pulmonary and Critical Care Medicine, Peking Union Medical College Hospital, Beijing, China
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Kozuma Y, Toyokawa G, Shoji F, Yamazaki K, Kawauchi S, Momosaki S, Takeo S. Squamous Cell Carcinoma Transformation as a Possible Resistant Mechanism Against Pembrolizumab Plus Chemotherapy. J Thorac Oncol 2019; 14:e238-e240. [DOI: 10.1016/j.jtho.2019.05.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 05/28/2019] [Accepted: 05/29/2019] [Indexed: 11/25/2022]
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Abdallah N, Nagasaka M, Abdulfatah E, Shi D, Wozniak AJ, Sukari A. Non-small cell to small cell lung cancer on PD-1 inhibitors: two cases on potential histologic transformation. LUNG CANCER-TARGETS AND THERAPY 2018; 9:85-90. [PMID: 30498383 PMCID: PMC6207227 DOI: 10.2147/lctt.s173724] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Introduction Histologic transformation from non-small cell lung cancer (NSCLC) to small cell lung cancer (SCLC) is a well-recognized mechanism of resistance in EGFR-mutant adenocarcinoma upon treatment with TKIs, but rarely reported with programmed death1 (PD-1) inhibitors. We report two cases of potential transformation during treatment with PD-1 inhibitors. Case presentations Case 1, a 65-year-old man was diagnosed with stage IVa lung adenocarcinoma on pleural fluid cytology. He received six cycles of carboplatin and pemetrexed, then maintained on pemetrexed. He had disease progression after nine cycles of pemetrexed and was switched to nivolumab. He progressed after five cycles of nivolumab. Core biopsy of the lung mass revealed SCLC. Case 2, a 68-year-old man was diagnosed with two primary NSCLCs and underwent resection. He had recurrence after several months and was treated with four cycles of carboplatin, paclitaxel, and pembrolizumab on clinical trial, with partial response. He was continued on pembrolizumab and had disease progression after 30 cycles. Biopsy of the new lesions showed SCLC. Discussion Histologic transformation from NSCLC to SCLC can be explained by the presence of a common cell precursor. Proposed molecular mechanisms include loss of RB1, TP53 mutations, and MYC amplification. The distinction between transformation and mixed histology tumors is challenging, especially when pathologic material used for the initial diagnosis is limited. The possibility of a second metachronous primary lung cancer cannot be excluded in our cases. Conclusion Histologic transformation with PD-1 inhibitors could be under-recognized. Disease progression should prompt re-biopsy to uncover new histology and change in treatment. Future studies are needed to elucidate mechanisms and predictors of transformation.
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Affiliation(s)
- Nadine Abdallah
- Department of Internal Medicine, Wayne State University, Detroit, MI 48201, USA
| | - Misako Nagasaka
- Department of Oncology, Barbara Ann Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, MI 48201, USA, .,Department of Advanced Medical Innovation, St. Marianna University Graduate School of Medicine, Kawasaki, Kanagawa, Japan
| | - Eman Abdulfatah
- Department of Pathology, School of Medicine, Wayne State University, Detroit, MI 48201, USA
| | - Dongping Shi
- Department of Pathology, School of Medicine, Wayne State University, Detroit, MI 48201, USA
| | - Antoinette J Wozniak
- Department of Oncology, Barbara Ann Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, MI 48201, USA,
| | - Ammar Sukari
- Department of Oncology, Barbara Ann Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, MI 48201, USA,
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