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Han X, Wang L, Wang EH. Sarcomatous transformation in metastatic EGFR-mutant lung adenocarcinoma after TKI treatment, a case report. Asian J Surg 2024:S1015-9584(24)01109-6. [PMID: 38834476 DOI: 10.1016/j.asjsur.2024.05.217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Accepted: 05/23/2024] [Indexed: 06/06/2024] Open
Affiliation(s)
- Xu Han
- Department of Pathology, The First Hospital and the College of Basic Medical Sciences, China Medical University, Shenyang, 110001, China
| | - Liang Wang
- Department of Pathology, The First Hospital and the College of Basic Medical Sciences, China Medical University, Shenyang, 110001, China.
| | - En-Hua Wang
- Department of Pathology, The First Hospital and the College of Basic Medical Sciences, China Medical University, Shenyang, 110001, China
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2
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Liang X, Guan Y, Wang B, Liu X, Wang J. Histological sarcomatoid transformation in a lung adenocarcinoma patient following immune checkpoint blockade. Ther Adv Med Oncol 2024; 16:17588359241236450. [PMID: 38455710 PMCID: PMC10919128 DOI: 10.1177/17588359241236450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Accepted: 02/15/2024] [Indexed: 03/09/2024] Open
Abstract
Histological transformation is a phenomenon that is well described as one of the causes of tyrosine kinase inhibitor resistance in oncogene-driven non-small-cell lung cancer (NSCLC). The use of immune checkpoint inhibitors (ICIs) as a potential mechanism of acquired resistance to immunotherapy in NSCLC to small-cell lung cancer was also recently found. Here, we report the histological transformation of sarcomatoid carcinoma and metastasis in a lung adenocarcinoma patient without targetable genetic alterations who experienced long-term disease remission after nivolumab therapy. The patient subsequently developed rapid progression in the mediastinal and retroperitoneal lymph nodes, bones, and small intestine. Surgical resection of the small intestine lesion due to acute small intestine bleeding revealed the transformation of NSCLC to sarcomatoid carcinoma. The patient died 3 months after sarcomatoid carcinoma transformation and extensive disease progression, although he was rechallenged with immunotherapy. Genomic and immunohistochemical analyses revealed a comparable abundance of gene mutations and a limited number of immune cells in the tumor microenvironment, with low infiltration of CD8+ T cells, CD4+ T cells, regulatory T cells, and PD-L1+ macrophages in metastatic tumors, revealing a noninflamed immune microenvironment for ICI-resistant tumors.
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Affiliation(s)
- Xiuju Liang
- Department of Oncology, 960th Hospital of the People’s Liberation Army, Jinan, China
| | - Yaping Guan
- Department of Oncology, The First Affiliated Hospital of Shandong First Medical University, Shandong Provincial Qianfoshan Hospital, Jinan, China
- Shandong Lung Cancer Institute, Jinan, China
- Shandong Key Laboratory of Rheumatic Disease and Translational Medicine, Jinan, China
| | - Baocheng Wang
- Department of Oncology, 960th Hospital of the People’s Liberation Army, Jinan, China
| | - Xiaohong Liu
- Department of Pathology, 960th Hospital of the People’s Liberation Army, No. 25, Shifan Road, Jinan 250031, China
| | - Jun Wang
- Department of Oncology, The First Affiliated Hospital of Shandong First Medical University, Shandong Provincial Qianfoshan Hospital, No. 16766, Jingshi Road, Jinan 250014, China
- Shandong Lung Cancer Institute, Jinan, China
- Shandong Key Laboratory of Rheumatic Disease and Translational Medicine, Jinan, China
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Lin MW, Yu SL, Hsu YC, Chen YM, Lee YH, Hsiao YJ, Lin JW, Su TJ, Jeffrey Yang CF, Chiang XH, Hsu HH, Chen JS, Hsieh MS. Salvage Surgery for Advanced Lung Adenocarcinoma After Epidermal Growth Factor Receptor Tyrosine Kinase Inhibitor Treatment. Ann Thorac Surg 2023; 116:111-119. [PMID: 36739067 DOI: 10.1016/j.athoracsur.2023.01.027] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 12/20/2022] [Accepted: 01/09/2023] [Indexed: 02/05/2023]
Abstract
BACKGROUND No published studies to date have evaluated the detailed pathologic and genetic features of lung adenocarcinoma after epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor (TKI) therapy and salvage surgery. We aimed to evaluate the pathologic and genetic changes of tumors in patients with advanced lung adenocarcinoma treated with EGFR TKI therapy and salvage surgery. METHODS This study retrospectively collected data from 29 advanced lung adenocarcinoma patients who underwent EGFR TKI therapy, followed by salvage operation, between January 2010 and December 2018. All patients had partial response or stable disease without evidence of progressive disease. Next-generation sequencing was used to determine whether acquired resistant mutations in morphologically treatment-sensitive and morphologically treatment-resistant regions of tumor existed. RESULTS There were 3, 22, and 4 patients with clinical stage IIIB, IVA, and IVB, respectively. After a mean TKI treatment duration of 134 days, 27 patients had partial response, 2 had stable disease, and 27.6% of patients were downstaged before salvage surgery. All patients had residual viable tumor cells in their tumor bed; 5 patients (17.2%) had a major pathologic response. Acquired T790M mutations (n = 4), histologic transformations (n = 2), and acquired T790M mutation with histologic transformation (n = 1) were identified in the morphologically treatment-resistant regions of tumors. The 3-year overall survival was 75.9%. CONCLUSIONS The presence of morphologically treatment-resistant tumor regions with acquired T790M mutations and histologic transformations demonstrate the existence of resistant subclones in TKI-treated tumors before disease progression. Salvage surgery performed in selected patients before disease progression may improve survival by removing TKI-resistant subclones.
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Affiliation(s)
- Mong-Wei Lin
- Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Sung-Liang Yu
- Department of Clinical Laboratory Science and Medical Biotechnology, College of Medicine, National Taiwan University, Taipei, Taiwan; Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan; Department of Laboratory Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Yin-Chen Hsu
- Department of Clinical Laboratory Science and Medical Biotechnology, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Yan-Ming Chen
- Department of Clinical Laboratory Science and Medical Biotechnology, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Yi-Hsuan Lee
- Department of Pathology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Yi-Jing Hsiao
- Department of Clinical Laboratory Science and Medical Biotechnology, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Jing-Wei Lin
- Department of Clinical Laboratory Science and Medical Biotechnology, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Te-Jen Su
- Department of Clinical Laboratory Science and Medical Biotechnology, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chi-Fu Jeffrey Yang
- Division of Thoracic Surgery, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Xu-Heng Chiang
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Hsao-Hsun Hsu
- Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Jin-Shing Chen
- Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Min-Shu Hsieh
- Department of Pathology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan; Department of Pathology, National Taiwan University Cancer Center, Taipei, Taiwan.
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He J, Ni J, Li G, Yao J, Ni B. Clinicopathological features and prognostic nomogram of giant cell carcinoma of the lung: A population-based study. THE CLINICAL RESPIRATORY JOURNAL 2023; 17:197-210. [PMID: 36718941 PMCID: PMC9978898 DOI: 10.1111/crj.13586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 12/14/2022] [Accepted: 01/09/2023] [Indexed: 02/01/2023]
Abstract
BACKGROUND Due to its rarity, the features and prognosis of giant cell carcinoma of the lung (GCCL) are not well defined. The present study aimed to describe the clinicopathological features and prognostic analysis of this rare disease, compare it with lung adenocarcinoma (LAC), further determine the prognostic factors and establish a nomogram. METHODS Patients diagnosed with GCCL and LAC were identified from the SEER database between 2004 and 2016. The features and survival between GCCL and LAC were compared in the unmatched and matched cohorts after propensity score matching (PSM) analysis. Univariate and multivariate Cox analyses were used to identify the prognostic factors, and a nomogram was constructed. Area under the curve (AUC), C-index, calibration curve and decision curve analysis (DCA) were used to confirm the established nomogram. RESULTS A total of 295 patient diagnosed with GCCL and 149 082 patients with LAC were identified. Compared with LAC, patients with GCCL tend to be younger, male, black and have pathological Grade III/IV GCCL, more proportion of AJCC-TNM-IV, T3/T4 and distant metastases. The 1-, 2- and 5-year OS rates of the patients with GCCL were 21.7%, 13.4% and 7.9%, respectively. The median OS and CSS were 3 and 4 months, respectively. Patients with GCCL had significantly shorter OS and CSS than those with LAC in the unmatched and matched cohorts after PSM. Multivariate Cox analysis demonstrated that T, N and M stages and use of chemotherapy and surgery were independent of survival. Furthermore, we constructed a prognostic nomogram for OS and CSS by using independent prognostic factors. The C-index of OS-specific nomogram is 0.78 (0.74-0.81), and the C-index of CSS-specific nomogram is 0.77 (0.73-0.80). The calibration curve and ROC analysis showed good predictive capability of these nomograms. DCA showed that the nomogram had greater clinical practical value in predicting the OS and CSS of GCCL than TNM staging. CONCLUSION GCCL have distinct clinicopathological characteristics and significantly worse clinical outcomes. Prognostic nomograms for overall survival (OS) and CSS were constructed.
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Affiliation(s)
- Jiang He
- Department of Thoracic SurgeryThe First Affiliated Hospital of Soochow UniversitySuzhouChina
| | - Jin‐Ping Ni
- Suzhou Kowloon HospitalShanghai Jiaotong University School of MedicineSuzhouChina
| | - Guang‐Bin Li
- Department of Thoracic SurgeryThe First Affiliated Hospital of Soochow UniversitySuzhouChina
| | - Jie Yao
- Department of Thoracic SurgeryThe First Affiliated Hospital of Soochow UniversitySuzhouChina
| | - Bin Ni
- Department of Thoracic SurgeryThe First Affiliated Hospital of Soochow UniversitySuzhouChina
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Zhou F, Guo H, Zhou X, Xie H, Tian T, Zhao W, Gao G, Xiong A, Wang L, Li W, Chen X, Zhang Y, Fan J, Wu F, Zhang Y, Zhou C. Immune checkpoint inhibitors plus chemotherapy in patients with locally advanced or metastatic pulmonary sarcomatoid carcinoma: a multicentric real-world study. Ther Adv Med Oncol 2022; 14:17588359221136759. [PMID: 36419724 PMCID: PMC9676284 DOI: 10.1177/17588359221136759] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Accepted: 10/14/2022] [Indexed: 08/08/2023] Open
Abstract
INTRODUCTION Immune checkpoint inhibitors (ICIs) have demonstrated promising efficacy as monotherapy in patients with pulmonary sarcomatoid carcinoma (PSC). We performed the current multi-institutional, real-world study to assess the efficacy of ICIs plus chemotherapy in patients with PSC. METHODS All consecutive patients with locally advanced or metastatic PSC from three centers treated with ICIs between January 2018 and July 2021 were enrolled. Programmed death ligand 1 (PD-L1) expression was stained and evaluated using immunohistochemical with 22C3. Single-cell RNA sequencing (scRNA-seq) was performed in two patients with PSC and two patients with adenocarcinoma to understand the cell-type-specific transcriptome landscape of cancer cells and tumor microenvironment (TME) of PSC. RESULTS A cohort of 42 PSC patients was identified. In the overall population, the objective response rate (ORR) was 73.8%, median progression-free survival (mPFS) was 10.3 months and median overall survival was not reached and 2-year survival rate was 51.2%. For 34 treatment-naïve patients who received first-line ICIs plus chemotherapy, the ORR was 70.6%, mPFS was 10.3 months and 2-year survival rate was 57.8%. In patients with PD-L1 tumor proportion score (TPS) < 1%, 1-49%, and ⩾50%, the ORR was 33.3%, 72.7%, and 85.7% and mPFS was 6.0, 6.7, and 10.3 months, respectively. Notably, two patients with transformed PSC from lung adenocarcinoma after epidermal growth factor receptor-tyrosine kinase inhibitor treatment also responded well to ICIs plus chemotherapy. scRNA-seq revealed immune-cell-inflamed TME, lower intratumoral heterogeneity, and activated immune response pathway in PSC. CONCLUSIONS Our study demonstrated remarkable efficacy of ICIs plus chemotherapy as first-line therapy for patient with locally advanced or metastatic PSC.
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Affiliation(s)
| | | | | | | | | | - Wencheng Zhao
- Department of Medical Oncology, Shanghai Pulmonary Hospital, Thoracic Cancer Institute, Tongji University School of Medicine, Shanghai, China
| | - Guanghui Gao
- Department of Medical Oncology, Shanghai Pulmonary Hospital, Thoracic Cancer Institute, Tongji University School of Medicine, Shanghai, China
| | - Anwen Xiong
- Department of Medical Oncology, Shanghai Pulmonary Hospital, Thoracic Cancer Institute, Tongji University School of Medicine, Shanghai, China
| | - Lei Wang
- Department of Medical Oncology, Shanghai Pulmonary Hospital, Thoracic Cancer Institute, Tongji University School of Medicine, Shanghai, China
| | - Wei Li
- Department of Medical Oncology, Shanghai Pulmonary Hospital, Thoracic Cancer Institute, Tongji University School of Medicine, Shanghai, China
| | - Xiaoxia Chen
- Department of Medical Oncology, Shanghai Pulmonary Hospital, Thoracic Cancer Institute, Tongji University School of Medicine, Shanghai, China
| | - Yan Zhang
- Singleron Biotechnologies, Nanjing, Jiangsu, China
| | - Jue Fan
- Singleron Biotechnologies, Nanjing, Jiangsu, China
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Ma Y, Li W, Li Z, Chen J, Wang H, Jiang T, Zhu J. Immunophenotyping of pulmonary sarcomatoid carcinoma. Front Immunol 2022; 13:976739. [PMID: 36341325 PMCID: PMC9633134 DOI: 10.3389/fimmu.2022.976739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 10/10/2022] [Indexed: 11/29/2022] Open
Abstract
Background Previous studies have suggested that patients with pulmonary sarcomatoid carcinoma (PSC)may benefit from immune checkpoint inhibitors (ICIs); however, relevant data are lacking. This study aimed to establish the immunophenotype of PSC by assessing PD-L1 and CD8+ T-cell infiltration. Methods A retrospective analysis of pathologically confirmed PSC cases from two centers was performed from January 2009 to May 2021. According to the infiltration of CD8+ T cells in different spatial regions, patients were classified into three types: immune-inflamed, immune-excluded, and immune desert. PD-L1 staining was also performed on the intratumoral region and the tumor proportion score (TPS) was used for scoring. Combined with CD8+ T-cell infiltration and PD-L1 expression in the intratumoral region, immunophenotyping can be divided into four types: type I (PD-L1+/CD8+, adaptive immune resistance), type II (PD-L1-/CD8-, immunologic ignorance), type III (PD-L1+/CD8-, intrinsic induction), and type IV (PD-L1-/CD8+, tolerance). Finally, correlation analysis was performed on the immunophenotype, clinicopathological characteristics, and outcomes of the patients. Results A total of 32 patients with PSC were included in the final analysis. Of these patients, 65.6% (21/32), 15.6% (5/32), and 18.8% (6/32) were classified as immune-inflamed, immune-excluded, and immune-desert, respectively. Notably, the immune-inflamed type is predominantly observed in pleomorphic carcinomas (PC, 66.7%). Moreover, among these participants, 19 (59.4%) were classified as PD-L1 positive according to the TPS score. In particular, 11 (34.4%) patients had PD-L1 TPS scores >50%. Next, we immunophenotyped patients with PSC based on CD8+ T cell infiltration and tumor cell PD-L1 expression (types I–IV). Type I (PD-L1+/CD8+, adaptive immune resistance) was the most prevalent subtype, accounting for 46.9% (15/32), followed by type II (PD-L1-/CD8-, immunological ignorance) (21.9%), type IV (PD-L1-/CD8+, tolerance) (18.7%), and type III (PD-L1+/CD8-, intrinsic induction) (12.5%). Finally, we performed a survival analysis and found that neither immunophenotype was a predictor of prognosis in patients with PSC. Multivariate analysis showed that pneumonectomy increased the risk of death by four times compared with lobectomy (RR: 4.1; 95% CI:1.3-12.4, P=0.014). Conclusion Patients with PSC are characterized by immune-inflamed type and type I (PD-L1+/CD8+, adaptive immune resistance), explaining the intrinsic reasons for their high response rate to immunotherapy.
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Affiliation(s)
- Yu Ma
- Department of Pathology, Shaanxi Provincial People’s Hospital, Xi’an, China
| | - Wensheng Li
- Department of Pathology, Shaanxi Provincial People’s Hospital, Xi’an, China
| | - Zhenzhen Li
- Department of Pathology, Shaanxi Provincial People’s Hospital, Xi’an, China
| | - Jie Chen
- Department of Pathology, Shaanxi Provincial People’s Hospital, Xi’an, China
| | - Hongtao Wang
- Department of Thoracic Surgery, Shaanxi Provincial People’s Hospital, Xi’an, China
| | - Tao Jiang
- Department of Thoracic Surgery, Tangdu Hospital, Fourth Military Medical University, Xi’an, China
- *Correspondence: Jianfei Zhu, ; Tao Jiang,
| | - Jianfei Zhu
- Department of Thoracic Surgery, Shaanxi Provincial People’s Hospital, Xi’an, China
- *Correspondence: Jianfei Zhu, ; Tao Jiang,
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7
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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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Corassa M, Abreu RF, de Lima VCC, Torrezan GT, Cavalher FP, Silva TN, Oliveira TBD, Freitas HC, Carraro DM, Costa FD. Rhabdomyosarcomatous Transformation as a Mechanism of Resistance to Osimertinib and Savolitinib in EGFR-Mutant Lung Adenocarcinoma With METamp After Osimertinib First-Line Treatment. JCO Precis Oncol 2022; 6:e2200367. [PMID: 36201715 DOI: 10.1200/po.22.00367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 08/09/2022] [Accepted: 08/19/2022] [Indexed: 06/16/2023] Open
Affiliation(s)
- Marcelo Corassa
- Medical Oncology Department, A.C. Camargo Cancer Center, R. Professor Antonio Prudente, São Paulo, Brazil
| | | | | | - Giovana Tardim Torrezan
- Genomics and Molecular Biology Group, International Research Center/CIPE, A.C. Camargo Cancer Center, São Paulo, Brazil
- National Institute of Science and Technology in Oncogenomics (INCITO), São Paulo, Brazil
| | - Felicia Peterson Cavalher
- Medical Oncology Department, A.C. Camargo Cancer Center, R. Professor Antonio Prudente, São Paulo, Brazil
| | | | - Thiago Bueno de Oliveira
- Medical Oncology Department, A.C. Camargo Cancer Center, R. Professor Antonio Prudente, São Paulo, Brazil
| | - Helano Carioca Freitas
- Medical Oncology Department, A.C. Camargo Cancer Center, R. Professor Antonio Prudente, São Paulo, Brazil
| | - Dirce Maria Carraro
- Genomics and Molecular Biology Group, International Research Center/CIPE, A.C. Camargo Cancer Center, São Paulo, Brazil
- National Institute of Science and Technology in Oncogenomics (INCITO), São Paulo, Brazil
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Saigí M, Carcereny E, Morán T, Cucurull M, Domènech M, Hernandez A, Martinez-Cardús A, Pros E, Sanchez-Cespedes M. Biological and clinical perspectives of the actionable gene fusions and amplifications involving tyrosine kinase receptors in lung cancer. Cancer Treat Rev 2022; 109:102430. [DOI: 10.1016/j.ctrv.2022.102430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 05/20/2022] [Accepted: 06/15/2022] [Indexed: 11/02/2022]
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10
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Mekheal E, Kapoor A, Roman S, Mekheal N, Millet C, Mekheal M, Maroules M. Pulmonary Carcinosarcoma: A Rare Disease With Challenging Diagnosis and Treatment. Cureus 2022; 14:e26901. [PMID: 35983399 PMCID: PMC9376117 DOI: 10.7759/cureus.26901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/15/2022] [Indexed: 11/05/2022] Open
Abstract
Pulmonary carcinosarcoma (PCS) is a rare type of non-small cell cancer. Overall, middle-aged and older smokers are the most affected age and sex groups. The diagnosis of PCS is difficult due to the absence of characteristic imaging findings. Additionally, preoperative biopsies do not usually reflect the heterologous nature of this tumor. Given the rarity of such tumors and the challenging diagnosis, the prognostic factors have not been established, and the overall prognosis remains poor. The valid therapeutic options are still limited. Here, we report a rare case of metastatic PCS that was accidentally discovered by imaging and properly diagnosed after surgical resection. The clinicopathological features, diagnostic tools, genetic theories, prognosis, and therapeutic options of this rare cancer are also discussed.
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Histological Transformation after Acquired Resistance to the Third-Generation EGFR-TKI in Patients with Advanced EGFR-Mutant Lung Adenocarcinoma. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58070908. [PMID: 35888627 PMCID: PMC9323036 DOI: 10.3390/medicina58070908] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 07/03/2022] [Accepted: 07/05/2022] [Indexed: 12/25/2022]
Abstract
Background and Objectives: Third-generation epidermal growth factor receptor (EGFR)-tyrosine kinase inhibitor (TKI) is one of the standard-of-care therapies in patients with EGFR-mutant lung adenocarcinoma; however, acquired resistance inevitably developed. Despite the proposition of histological transformation being one of the resistance mechanisms, its incidence and influence on outcome remain unclear. Materials and Methods: This was a retrospective study conducted at Taichung Veterans General Hospital on patients with advanced EGFR-mutant lung adenocarcinoma receiving the third-generation EGFR-TKI. Only patients receiving rebiopsy were included in the analysis. Results: A total of 55 patients were studied. Eight patients (14.5%) showed histological transformation, including three small cell carcinoma, three squamous cell carcinoma, one large cell neuroendocrine carcinoma, and one with a mixture of adenocarcinoma and squamous cell carcinoma components. The median treatment duration of the third-generation EGFR-TKI before rebiopsy was numerically longer in patients with histological transformation than those without (16.0 vs. 10.9 months). Both the overall survival time from the start of third-generation EGFR-TKI initiation (30.8 vs. 41.2 months) and from rebiopsy (6.6 vs. 12.9 months) to mortality were numerically shorter amongst the transformed population. All patients in the transformed group did not respond to the next line of systemic treatment. One patient with histological transformation receiving local treatment for the metastatic site had a longer overall survival. Conclusions: Repeating biopsy to identify histological transformation should be considered in patients with progression to the third-generation EGFR-TKI. Histological transformations could contribute to the acquired resistance with the implication of a worse prognosis. Further studies are needed to determine the optimal therapy for these patients.
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12
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Shah I, Razzak AN, Janardan A, Laing B, Zwagerman NT. A Rare Case of Neck Sarcomatoid Squamous Cell Carcinoma With Brain Metastases. Cureus 2022; 14:e26179. [PMID: 35891819 PMCID: PMC9304508 DOI: 10.7759/cureus.26179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/21/2022] [Indexed: 11/12/2022] Open
Abstract
Squamous cell carcinoma (SCC) is the second most prominent form of skin malignancy. It occurs most frequently in older males with fair skin complexion that have extensive sun exposure most commonly in their childhood. The metastatic presentation of SCC is rare and is most common in the lung. In this paper, we present the unique case of a 73-year-old patient with sarcomatoid squamous cell carcinoma in their posterior neck that metastasized to the brain.
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Passaro A, Leighl N, Blackhall F, Popat S, Kerr K, Ahn MJ, Arcila ME, Arrieta O, Planchard D, de Marinis F, Dingemans AM, Dziadziuszko R, Faivre-Finn C, Feldman J, Felip E, Curigliano G, Herbst R, Jänne PA, John T, Mitsudomi T, Mok T, Normanno N, Paz-Ares L, Ramalingam S, Sequist L, Vansteenkiste J, Wistuba II, Wolf J, Wu YL, Yang SR, Yang JCH, Yatabe Y, Pentheroudakis G, Peters S. ESMO expert consensus statements on the management of EGFR mutant non-small-cell lung cancer. Ann Oncol 2022; 33:466-487. [PMID: 35176458 DOI: 10.1016/j.annonc.2022.02.003] [Citation(s) in RCA: 69] [Impact Index Per Article: 34.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 01/14/2022] [Accepted: 02/06/2022] [Indexed: 12/14/2022] Open
Abstract
The European Society for Medical Oncology (ESMO) held a virtual consensus-building process on epidermal growth factor receptor (EGFR)-mutant non-small-cell lung cancer in 2021. The consensus included a multidisciplinary panel of 34 leading experts in the management of lung cancer. The aim of the consensus was to develop recommendations on topics that are not covered in detail in the current ESMO Clinical Practice Guideline and where the available evidence is either limited or conflicting. The main topics identified for discussion were: (i) tissue and biomarkers analyses; (ii) early and locally advanced disease; (iii) metastatic disease and (iv) clinical trial design, patient's perspective and miscellaneous. The expert panel was divided into four working groups to address questions relating to one of the four topics outlined above. Relevant scientific literature was reviewed in advance. Recommendations were developed by the working groups and then presented to the entire panel for further discussion and amendment before voting. This manuscript presents the recommendations developed, including findings from the expert panel discussions, consensus recommendations and a summary of evidence supporting each recommendation.
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Affiliation(s)
- A Passaro
- Division of Thoracic Oncology, European Institute of Oncology IRCCS, Milan, Italy.
| | - N Leighl
- Division of Medical Oncology/Hematology, Princess Margaret Hospital Cancer Centre, Toronto, Canada
| | - F Blackhall
- Division of Cancer Sciences, The University of Manchester, Manchester, UK; Department of Medical Oncology, The Christie National Health Service (NHS) Foundation Trust, Manchester, UK
| | - S Popat
- National Heart and Lung Institute, Imperial College, London, UK; Lung Unit, Royal Marsden Hospital, London, UK; The Institute of Cancer Research, London, UK
| | - K Kerr
- Aberdeen Royal Infirmary, Aberdeen University Medical School, Aberdeen, UK
| | - M J Ahn
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - M E Arcila
- Department of Pathology, Molecular Diagnostics Service, Memorial Sloan Kettering Cancer Center, New York, USA
| | - O Arrieta
- Thoracic Oncology Unit, Instituto Nacional de Cancerología, Mexico City, Mexico
| | - D Planchard
- Department of Medical Oncology, Gustave Roussy, Villejuif, France
| | - F de Marinis
- Division of Thoracic Oncology, European Institute of Oncology IRCCS, Milan, Italy
| | - A M Dingemans
- Department of Respiratory Medicine, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - R Dziadziuszko
- Department of Oncology and Radiotherapy, Medical University of Gdańsk, Gdansk, Poland
| | - C Faivre-Finn
- The University of Manchester, Manchester Academic Health Science Centre, The Christie NHS Foundation Trust, Manchester, UK
| | - J Feldman
- Lung Cancer Patient and Advocate, Co-Founder of EGFR Resisters Patient Group
| | - E Felip
- Department of Medical Oncology, Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | - G Curigliano
- Department of Oncology and Hemato-Oncology, University of Milano, European Institute of Oncology IRCCS, Milan, Italy
| | - R Herbst
- Yale Comprehensive Cancer Center, Yale University School of Medicine, New Haven, USA
| | - P A Jänne
- Lowe Center for Thoracic Oncology, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, USA
| | - T John
- Peter MacCallum Cancer Centre, Melbourne, Australia
| | - T Mitsudomi
- Division of Thoracic Surgery, Department of Surgery, Kindai University Faculty of Medicine, Osaka-Sayama, Japan
| | - T Mok
- State Key Laboratory of Translational Oncology, Chinese University of Hong Kong, Shatin, Hong Kong Special Administrative Region, Hong Kong, China
| | - N Normanno
- Cell Biology and Biotherapy and Scientific Directorate, Istituto Nazionale Tumori, "Fondazione G.Pascale" IRCCS, Naples, Italy
| | - L Paz-Ares
- Lung Cancer Clinical Research Unit, and Complutense University, Madrid, Spain
| | - S Ramalingam
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Atlanta, Georgia
| | - L Sequist
- Department of Medicine, Massachusetts General Hospital, Boston, USA
| | - J Vansteenkiste
- Department of Respiratory Oncology, University Hospital KU Leuven, Leuven, Belgium
| | - I I Wistuba
- Department of Translational Molecular Pathology, Unit 951, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - J Wolf
- Lung Cancer Group Cologne, Department I for Internal Medicine and Center for Integrated Oncology Cologne/Bonn, University Hospital Cologne, Cologne, Germany
| | - Y L Wu
- Guangdong Lung Cancer Institute, Guangdong Provincial People's Hospital and Guangdong Academy of Medical Sciences, Guangdong, China
| | - S R Yang
- The Institute of Cancer Research, London, UK
| | - J C H Yang
- Department of Oncology, National Taiwan University Hospital and National Taiwan University Cancer Center, Taipei, Republic of China
| | - Y Yatabe
- Department of Diagnostic Pathology, National Cancer Center Hospital, Tokyo, Japan
| | - G Pentheroudakis
- Department of Medical Oncology, University of Ioannina, Ioannina, Epirus, Greece
| | - S Peters
- Oncology Department - CHUV, Lausanne University, Lausanne, Switzerland
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14
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Xie X, Chen X, Luo N, Qi Y, Li M, Feng X. Transformation of invasive lung adenocarcinoma with ALK rearrangement into pulmonary sarcomatoid carcinoma. J Cancer Res Clin Oncol 2022; 148:2165-2168. [DOI: 10.1007/s00432-022-04022-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 04/09/2022] [Indexed: 12/24/2022]
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15
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Calabrese F, Pezzuto F, Lunardi F, Fortarezza F, Tzorakoleftheraki SE, Resi MV, Tiné M, Pasello G, Hofman P. Morphologic-Molecular Transformation of Oncogene Addicted Non-Small Cell Lung Cancer. Int J Mol Sci 2022; 23:ijms23084164. [PMID: 35456982 PMCID: PMC9031930 DOI: 10.3390/ijms23084164] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 04/04/2022] [Accepted: 04/07/2022] [Indexed: 02/05/2023] Open
Abstract
Patients with non-small cell lung cancer, especially adenocarcinomas, harbour at least one oncogenic driver mutation that can potentially be a target for therapy. Treatments of these oncogene-addicted tumours, such as the use of tyrosine kinase inhibitors (TKIs) of mutated epidermal growth factor receptor, have dramatically improved the outcome of patients. However, some patients may acquire resistance to treatment early on after starting a targeted therapy. Transformations to other histotypes—small cell lung carcinoma, large cell neuroendocrine carcinoma, squamous cell carcinoma, and sarcomatoid carcinoma—have been increasingly recognised as important mechanisms of resistance and are increasingly becoming a topic of interest for all specialists involved in the diagnosis, management, and care of these patients. This article, after examining the most used TKI agents and their main biological activities, discusses histological and molecular transformations with an up-to-date review of all previous cases published in the field. Liquid biopsy and future research directions are also briefly discussed to offer the reader a complete and up-to-date overview of the topic.
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Affiliation(s)
- Fiorella Calabrese
- Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padova, 35128 Padova, Italy; (F.P.); (F.L.); (F.F.); (M.T.)
- Correspondence: ; Tel.: +39-049-827-2268
| | - Federica Pezzuto
- Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padova, 35128 Padova, Italy; (F.P.); (F.L.); (F.F.); (M.T.)
| | - Francesca Lunardi
- Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padova, 35128 Padova, Italy; (F.P.); (F.L.); (F.F.); (M.T.)
| | - Francesco Fortarezza
- Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padova, 35128 Padova, Italy; (F.P.); (F.L.); (F.F.); (M.T.)
| | | | - Maria Vittoria Resi
- Department of Surgery, Oncology and Gastroenterology, University of Padova, 35128 Padova, Italy; (M.V.R.); (G.P.)
- Medical Oncology 2, Istituto Oncologico Veneto IOV-IRCSS, Padova, 35128 Padova, Italy
| | - Mariaenrica Tiné
- Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padova, 35128 Padova, Italy; (F.P.); (F.L.); (F.F.); (M.T.)
| | - Giulia Pasello
- Department of Surgery, Oncology and Gastroenterology, University of Padova, 35128 Padova, Italy; (M.V.R.); (G.P.)
- Medical Oncology 2, Istituto Oncologico Veneto IOV-IRCSS, Padova, 35128 Padova, Italy
| | - Paul Hofman
- Laboratoire de Pathologie Clinique et Expérimentale, FHU OncoAge, Biobank BB-0033-00025, Université Côte d’Azur, 06000 Nice, France;
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16
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Zhang X, Wang X, Jia L, Yang Y, Yang F, Xiao S. CtBP1 Mediates Hypoxia-Induced Sarcomatoid Transformation in Hepatocellular Carcinoma. J Hepatocell Carcinoma 2022; 9:57-67. [PMID: 35186805 PMCID: PMC8847960 DOI: 10.2147/jhc.s340471] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 02/02/2022] [Indexed: 11/23/2022] Open
Abstract
Background Sarcomatoid hepatocellular carcinoma (sHCC), a highly aggressive subtype of hepatocellular carcinoma (HCC), mostly transforms from classical hepatocellular carcinoma (cHCC). The study intended to explore the role of C-terminal binding protein 1 (CtBP1) in sarcomatoid transformation of hepatocellular carcinoma. Methods Western blotting and/or immunohistochemistry were used to confirm the expression of CtBP1 and other proteins in HCC cells, xenografts and clinical tissue samples. CtBP1 shRNA-expressing lentivirus was used to infect HepG2 cells to construct CtBP1 knockdown cells. Cell migration was determined by scratch wound assays and Transwell assays. Immunofluorescence was used to label the a-tubulin cytoskeleton to evaluate cell morphology. HepG2 cells were inoculated subcutaneously in nude mice to construct xenografts and beneath the liver capsule to evaluate in vivo metastasis. Results Compared to that in the cHCC area, CtBP1 expression was significantly upregulated in the sHCC area, as shown by immunohistochemistry. HE staining showed that cells in the sHCC area were spindle-shaped, while those in the cHCC area were polygonal. Immunohistochemically, the epithelial markers pancytokeratin (CK) and E-cadherin were partially or completely lost, while the expression of the mesenchymal marker vimentin was upregulated in the sHCC area. Moreover, HepG2, an HCC cell line with high expression of CtBP1, autonomously underwent sarcomatoid transformation, showing a sarcomatoid morphology and phenotype. HIF1a expression was upregulated in epithelial cells adjacent to the sHCC area. Hypoxia upregulated CtBP1 protein expression and induced an EMT phenotype with increased migration and a spindle-shaped morphology in HepG2 cells. Knockdown of CtBP1 partially reversed the EMT phenotype induced by hypoxia. Silencing CtBP1 completely blocked the sarcomatoid transformation of subcutaneous xenografts and decreased lung metastasis in subcapsular xenografts of the liver in nude mice. Conclusion CtBP1 plays a key role in hypoxia-induced EMT and sarcomatoid transformation in HCC and could be a candidate target for the management of sHCC.
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Affiliation(s)
- Xiaoling Zhang
- Department of Physiology, Faculty of Basic Medical Science, Guilin Medical University, Guilin, People’s Republic of China
- Key Laboratory of Tumor Immunology and Microenvironmental Regulation of Guangxi, Guilin Medical University, Guilin, People’s Republic of China
- Xiaoling Zhang, Department of Physiology, Faculty of Basic Medical Science, Guilin Medical University, No. 1, Zhiyuan Road, Guilin, Guangxi Province, 541100, People’s Republic of China, Email
| | - Xiaoyu Wang
- Department of Pathology, the Second Affiliated Hospital of Guilin Medical University, Guilin, People’s Republic of China
| | - Liting Jia
- Department of Pathology, Affiliated Hospital of Hebei Engineering University, Handan, People’s Republic of China
| | - Yang Yang
- Department of Pathology, General Hospital of Central Theater Command, Wuhan, People’s Republic of China
| | - Fan Yang
- Department of Pathology, the Second Affiliated Hospital of Guilin Medical University, Guilin, People’s Republic of China
| | - Shengjun Xiao
- Key Laboratory of Tumor Immunology and Microenvironmental Regulation of Guangxi, Guilin Medical University, Guilin, People’s Republic of China
- Department of Pathology, the Second Affiliated Hospital of Guilin Medical University, Guilin, People’s Republic of China
- Department of Pathology, Guangxi Health Commission Key Laboratory of Glucose and Lipid Metabolism Disorders, the Second Affiliated Hospital of Guilin Medical University, Guilin, People’s Republic of China
- Correspondence: Shengjun Xiao, Department of Pathology, The Second Affiliated Hospital, Guilin Medical University, No. 212, Renmin Road, Guilin, Guangxi Province, 541199, People’s Republic of China, Email
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17
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Pathak R, Villaflor VM. Histologic Transformation in EGFR-Mutant Lung Adenocarcinomas: Mechanisms and Therapeutic Implications. Cancers (Basel) 2021; 13:4641. [PMID: 34572868 PMCID: PMC8470834 DOI: 10.3390/cancers13184641] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 09/10/2021] [Accepted: 09/14/2021] [Indexed: 02/03/2023] Open
Abstract
With the advent of potent EGFR tyrosine kinase inhibitors (TKIs), the treatment landscape of EGFR-mutant lung adenocarcinomas has changed drastically in recent years. However, the development of resistance to EGFR TKIs remains a critical barrier to improving survival in these patients. Histologic transformations to small cell lung carcinoma, large cell neuroendocrine carcinoma, squamous cell carcinoma, and the sarcomatoid phenotype have been increasingly recognized as important mechanisms of resistance. In this article, we summarize the known biological bases for such phenotypic switches in regard to EGFR TKIs and describe novel pathways that might be harnessed to develop effective novel therapies for patients with EGFR-mutant non-small cell lung cancers.
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Affiliation(s)
| | - Victoria M. Villaflor
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, CA 91010, USA;
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18
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Aichouni N, Kora C, Thouil A, Kouismi H, Marouf R, Kamaoui I, Nasri S, Skiker I. Report of Two Pulmonary Sarcomatoïd Carcinoma Cases With Highlights on the Computed Tomography Features. Cureus 2021; 13:e16935. [PMID: 34513505 PMCID: PMC8412881 DOI: 10.7759/cureus.16935] [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] [Accepted: 08/05/2021] [Indexed: 11/19/2022] Open
Abstract
Pulmonary sarcomatoïd carcinomas are a heterogeneous group of poorly differentiated non-small cell tumors with a sarcomatous component. On imaging, they appear as peripheral or central masses, sometimes excavated. We report two cases of pulmonary sarcomatoïd lung carcinoma. The first case involves a 73-year-old active smoker who presented with dyspnea. A computed tomography (CT) scan showed a large locally advanced left lower lobar tumor process. A CT-guided biopsy was performed and the histopathological examination concluded a pulmonary sarcomatoïd carcinoma. The second case involves a 52-year-old chronic smoker who presented with hemoptysis. CT pulmonary angiography showed an excavated right upper lobar tumor. Histologic work-up of the right upper lobectomy piece objectified a pulmonary sarcomatoïd carcinoma. Pulmonary sarcomatoïd carcinoma has a nonspecific appearance on imaging and should be a part of imaging differential diagnoses in front of a large, lobulated, highly invasive lung tumor with or without excavation.
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Affiliation(s)
- Narjisse Aichouni
- Radiology, Mohammed VI University Hospital, University Mohammed First, Faculty of Medicine and Pharmacy, Oujda, MAR
| | - Christine Kora
- Radiology, Mohammed VI University Hospital, University Mohammed First, Faculty of Medicine and Pharmacy, Oujda, MAR
| | - Afaf Thouil
- Pneumology, Mohammed VI University Hospital, University Mohammed First, Faculty of Medicine and Pharmacy, Oujda, MAR
| | - Hatim Kouismi
- Pneumology, Mohammed VI University Hospital, University Mohammed First, Faculty of Medicine and Pharmacy, Oujda, MAR
| | - Rachid Marouf
- Thoracic Surgery, Mohammed VI University Hospital, University Mohammed First, Faculty of Medicine and Pharmacy, Oujda, MAR
| | - Imane Kamaoui
- Radiology, Mohammed VI University Hospital, University Mohammed First, Faculty of Medicine and Pharmacy, Oujda, MAR
| | - Siham Nasri
- Radiology, Mohammed VI University Hospital, University Mohammed First, Faculty of Medicine and Pharmacy, Oujda, MAR
| | - Imane Skiker
- Radiology, Mohammed VI University Hospital, University Mohammed First, Faculty of Medicine and Pharmacy, Oujda, MAR
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19
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Transformation of Two Cases of Lung Adenocarcinoma into Pulmonary Sarcomatoid Carcinoma following Treatment. Can Respir J 2021; 2021:6661772. [PMID: 33488884 PMCID: PMC7796848 DOI: 10.1155/2021/6661772] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 12/10/2020] [Accepted: 12/28/2020] [Indexed: 11/25/2022] Open
Abstract
Accumulating evidence shows that histologic transformation is involved in the drug resistance of lung cancer. Moreover, it is common for lung adenocarcinoma to transform into small-cell lung cancer or squamous cell carcinoma; however, clinical cases with sarcomatoid transformation have been rarely reported. Thus, both the diagnosis and treatment of lung adenocarcinoma with sarcomatoid transformation remain difficult. Here, we discuss two patients with lung adenocarcinoma with sarcomatoid transformation—analyzing the diagnosis, clinical features, immunohistochemical characteristics, therapy, and prognosis—with the hope that this report will be used as a reference for future treatment of these patients.
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20
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Yang ZY, Liu ZY, Mu CY, Jiang JH. Letter: Exploring the accuracy of biopsy in diagnosis of pulmonary sarcomatoid carcinoma. Lung Cancer 2020; 151:97. [PMID: 33143859 DOI: 10.1016/j.lungcan.2020.10.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 10/18/2020] [Indexed: 11/19/2022]
Affiliation(s)
- Zhen-Yu Yang
- Department of Respiratory and Critical Care Medicine, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, 215000, China
| | - Zi-Yi Liu
- Department of Respiratory and Critical Care Medicine, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, 215000, China
| | - Chuan-Yong Mu
- Department of Respiratory and Critical Care Medicine, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, 215000, China.
| | - Jun-Hong Jiang
- Department of Respiratory and Critical Care Medicine, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, 215000, China.
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21
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Li X, Wu D, Liu H, Chen J. Pulmonary sarcomatoid carcinoma: progress, treatment and expectations. Ther Adv Med Oncol 2020; 12:1758835920950207. [PMID: 32922522 PMCID: PMC7450456 DOI: 10.1177/1758835920950207] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 07/23/2020] [Indexed: 01/10/2023] Open
Abstract
Pulmonary sarcomatoid carcinoma (PSC) is a unique, highly invasive pulmonary malignancy with a poor prognosis, representing 0.1-0.4% of all malignant lung tumors. Because of its highly aggressive character and propensity for frequent metastasis, PSC shows low response rates to traditional treatments such as chemotherapy, radiotherapy, and neoadjuvant therapy. In recent years, considerable progress has been made in gene sequencing, targeted therapies, and immunotherapies. One of the most promising treatment approaches is the selection of mono-targeted or multi-targeted drugs according to tumor gene-mutation sites, such as epidermal growth factor receptor or vascular endothelial growth factor receptor 2 (EGFR/VEGFR2), anaplastic lymphoma kinase (ALK), and others. Another approach is the activation of therapeutic anti-tumor immunity via pathways including programmed cell-death protein-1/programmed cell-death ligand-1 (PD-1/PD-L1), which has been used in individual cases. In this review, we will introduce the clinicopathologic features, molecular typing, and traditional treatments. We will also review the biological characteristics and the latest therapies for PSC. These novel therapies show promise in the management of PSC, and the outcomes of investigative trials will hopefully reveal a variety of treatment options for patients with PSC.
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Affiliation(s)
- Xin Li
- Department of Lung Cancer Surgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Di Wu
- Department of Lung Cancer Surgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Hongyu Liu
- Tianjin Key Laboratory of Lung Cancer Metastasis and Tumor Microenvironment, Tianjin Medical University General Hospital, Tianjin, China
| | - Jun Chen
- Department of Lung Cancer Surgery, Tianjin Key Laboratory of Lung Cancer Metastasis and Tumor Microenvironment, Tianjin Lung Cancer Institute, Tianjin Medical University General Hospital, Anshan Road no.154, Heping District, Tianjin 300052, China
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22
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Lee PH, Chang GC. Transformations First Into Squamous-Cell Carcinoma and Later Into Sarcomatoid Carcinoma After Acquired Resistance to Osimertinib in a Patient With EGFR-Mutant Lung Adenocarcinoma: Case Report. Clin Lung Cancer 2020; 22:e536-e541. [PMID: 32839131 DOI: 10.1016/j.cllc.2020.06.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 06/11/2020] [Accepted: 06/29/2020] [Indexed: 02/05/2023]
Affiliation(s)
- Po-Hsin Lee
- Division of Chest Medicine, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Gee-Chen Chang
- Division of Chest Medicine, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan; Institute of Biomedical Sciences, National Chung Hsing University, Taichung, Taiwan; Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan; Division of Pulmonary Medicine, Department of Internal Medicine, Chung Shan Medical University, Taichung, Taiwan; Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan; School of Medicine, Chung Shan Medical University, Taichung, Taiwan.
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23
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Zheng J, Zhu J, Zhang K, Yuan M, Chen M, Chen R, Li X. Temporal Heterogeneity of Resistance Mechanisms to EGFR-TKI Identified in a Patient With Lung Adenocarcinoma and Sarcomatoid Transformation. Clin Lung Cancer 2020; 21:e255-e257. [PMID: 32122806 DOI: 10.1016/j.cllc.2020.02.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 01/10/2020] [Accepted: 02/01/2020] [Indexed: 12/15/2022]
Affiliation(s)
- Jinyang Zheng
- Department of Pathology, Affiliated Quanzhou First Hospital of Fujian Medical University, Quanzhou, China
| | - Jinfeng Zhu
- Department of Oncology, Affiliated Quanzhou First Hospital of Fujian Medical University, Quanzhou, China
| | - Kelian Zhang
- Department of Cardiology, Affiliated Quanzhou First Hospital of Fujian Medical University, Quanzhou, China
| | | | - Mujin Chen
- Department of Oncology, Affiliated Quanzhou First Hospital of Fujian Medical University, Quanzhou, China
| | | | - Xiaofeng Li
- Department of Oncology, Affiliated Quanzhou First Hospital of Fujian Medical University, Quanzhou, China.
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24
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Baldovini C, Rossi G, Ciarrocchi A. Approaches to Tumor Classification in Pulmonary Sarcomatoid Carcinoma. LUNG CANCER-TARGETS AND THERAPY 2019; 10:131-149. [PMID: 31824199 PMCID: PMC6901065 DOI: 10.2147/lctt.s186779] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Accepted: 11/26/2019] [Indexed: 12/13/2022]
Abstract
Pulmonary sarcomatoid carcinoma (PSC) is a heterogeneous category of primary lung cancer accounting from 0.3% to 3% of all primary lung malignancies. According to the most recent 2015 World Health Organization (WHO) classification, PSC includes several different variants of malignant epithelial tumors (carcinomas) histologically mimicking sarcomas showing or entirely lacking a conventional component of non-small cell lung cancer (NSCLC). Thus, this rare subheading of lung neoplasms includes pleomorphic carcinoma, spindle cell carcinoma, giant cell carcinoma, pulmonary blastoma, and carcinosarcoma. A diagnosis of PSC may be suspected on small biopsy or cytology, but commonly requires a surgical resection to reach a conclusive definition. The majority of patients with PSC consists of elderly, smoking men with a large, peripheral mass characterized by well-defined margins. However, presentation with a central, polypoid endobronchial lesion is well-documented, particularly in pleomorphic carcinoma and carcinosarcoma showing a squamous cell carcinoma component. As expected, PSC may pose diagnostic problems and immunohistochemistry is largely used when pathologists deal these tumors in routine practice. Indeed, PSC tends to overexpress molecules associated with the epithelial-to-mesenchymal transition, such as vimentin, but the panel of immunostains also includes epithelial markers (cytokeratins, EMA), TTF-1, p40 and negative markers (e.g., melanocytic, mesothelial and sarcoma-related primary antibodies). Although rare, PSC has increased their interest among oncologist community for different reasons: a. identification of the epithelial-to-mesenchymal phenomenon as a major mechanism of secondary resistance to tyrosine kinase inhibitors; b. over-expression of PD-L1 and effective treatment with immunotherapy; c. identification of c-MET exon 14 skipping mutation representing an effective target to crizotinib and other specific inhibitors. In this review, the feasibility of the diagnosis of PSC, its differential diagnosis and novel molecular findings characterizing this group of lung tumor are discussed.
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Affiliation(s)
- Chiara Baldovini
- Operative Unit of Pathologic Anatomy, Azienda USL della Romagna, Hospital S. Maria delle Croci, Ravenna, Italy
| | - Giulio Rossi
- Operative Unit of Pathologic Anatomy, Azienda USL della Romagna, Hospital S. Maria delle Croci, Ravenna, Italy
| | - Alessia Ciarrocchi
- Laboratory of Translational Research, Azienda Unità Sanitaria Locale - IRCCS Reggio Emilia, Reggio Emilia 42123, Italy
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