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Bao Z, Yu X, Zheng K, Zhai K, Cui H, Xu M. Case report: Sintilimab combined with anlotinib as neoadjuvant chemotherapy for metastatic bone tumor resection in patients with PSC. Front Immunol 2024; 15:1372279. [PMID: 38756778 PMCID: PMC11096473 DOI: 10.3389/fimmu.2024.1372279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 04/17/2024] [Indexed: 05/18/2024] Open
Abstract
Background Pulmonary sarcomatoid carcinoma (PSC) is a rare subtype of non-small-cell lung cancer (NSCLC), which is resistant to chemotherapy and radiotherapy with a poor prognosis. PSC is highly malignant and is prone to recurrence even after surgery. The programmed death-ligand 1 (PD-L1) tumor cell proportion score (TPS) 5%, TERT and TP53 gene mutations were detected in this patient accompanied by multiple metastatic sites. The anlotinib is a novel multitarget tyrosine kinase inhibitor (TKI) that could be effective for advanced NSCLC and some sarcoma patients. Limited clinical trials and case reports have shown that PSC patients with gene mutations and PD-L1 expression have good responses to multitarget antiangiogenic drug and immune checkpoint inhibitors (ICIs). In this article, we reported a case with metastatic PSC diagnosed by Computed Tomography (CT)-guided needle biopsy treated with immunotherapy combined with antiangiogenic drugs as a neoadjuvant chemotherapy (NACT). PSC is controlled and the patient achieves successfully limb salvage treatment by surgical resection. Therefore, targeted therapy and immunotherapy can provide sufficient surgical opportunities for limb salvage in the treatment of metastatic PSC patients. Case summary A 69-year-old male diagnosed with malignant bone tumor in the proximal femur was admitted to our hospital in June 2022 with recurrent fever as well as swelling and pain in the left thigh for twenty days. The initial computed tomography (CT) scan of the chest showed a pulmonary cavity (20 mm × 30 mm) and scattered lung masses. Subsequently, he underwent a CT-guided needle biopsy to distinguish the essence of osteolytic bone destruction and soft tissue mass in the left proximal femur which showed metastatic sarcomatoid carcinoma histology. Genetic testing revealed TERT c.-124C mutation (abundance 8.81%), TP53 p.R342 mutation (abundance 11.35%), tumor mutational burden (TMB) 7.09 muts/Mb, microsatellite stability (MSS), and PD-L1 (SP263) TPS 5% were also detected. The patient was tentatively treated with a combination of antiangiogenic drug and PD-1 inhibitor. After one course, the tumor volume significantly reduced in magnetic resonance imaging (MRI) and pathological fracture occurred in the femur after combined treatment. The patient received proximal femoral tumor resection and prosthesis replacement after defervescence. Sequentially sintilimab with anlotinib were administered for over 1 year. Finally, the local tumor was well controlled, and no obvious drug-related adverse reactions were observed. The lesions in the lung remained in partial response (PR) for more than 16 months and complete response (CR) of metastatic tumor in the proximal femur was observed through imaging examinations. Conclusion This is the first reported case of a metastatic PSC in femur showing a favorable response to the treatment consisting of anlotinib combined with sintilimab. This case suggests that antiangiogenic therapy combined with immunotherapy may benefit patients with metastatic PSC in the preoperative adjuvant therapy for limb salvage.
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Affiliation(s)
| | | | | | | | | | - Ming Xu
- Orthopedics Department, 960th Hospital of People's Liberation Army (PLA) Joint Service Support Force, Jinan, China
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Guo Y, Liu X, Tang H, Qiu Z, Ma F, Hu A, Liu C, Wang Y. Case report: Pathological complete response induced by immunochemotherapy in a case of Pulmonary Sarcomatoid Carcinoma staged IIIA-N2. Front Immunol 2024; 15:1374270. [PMID: 38650938 PMCID: PMC11033314 DOI: 10.3389/fimmu.2024.1374270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2024] [Accepted: 03/25/2024] [Indexed: 04/25/2024] Open
Abstract
Pulmonary sarcomatoid carcinoma (PSC) represents a rare and highly aggressive variant of lung cancer, characterized by its recalcitrance to conventional therapeutic modalities and the attendant dismal prognosis it confers. Recent breakthroughs in immunotherapy have presented novel prospects for PSC patients; nevertheless, the utility of neoadjuvant/conversional immunotherapy in the context of PSC remains ambiguous. In this report, we present a middle-aged male presenting with Stage III PSC, notable for its high expression of the programmed death-ligand 1 (PD-L1), initially deemed as non-resectable for sizeable tumor mass and multiple lymph nodes metastases. The patient underwent a transformation to a resectable state after a regimen of three cycles of platinum-based chemotherapy plus immunotherapy. Following definitive surgical resection, the individual realized a pathological complete response (pCR), culminating in a significant prolongation of event-free survival (EFS). This case underscores the viability of employing immunochemotherapy as a neoadjuvant/conversional strategy for chosen cases of PSC.
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Affiliation(s)
- Yishu Guo
- Department of Oncology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Xianling Liu
- Department of Oncology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Hao Tang
- Department of Cardio-thoracic Surgery, The Third Xiangya Hospital, Changsha, China
| | - Zhenhua Qiu
- Department of Oncology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Fang Ma
- Department of Oncology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Ao’ran Hu
- Department of Oncology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Chaoyuan Liu
- Department of Oncology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Yapeng Wang
- Department of Oncology, The Second Xiangya Hospital, Central South University, Changsha, China
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Luo ZH, Luo XY, Qi WL, Liu Q. 18F-FDG PET/CT imaging in pulmonary sarcomatoid carcinoma. Front Oncol 2024; 14:1334156. [PMID: 38420021 PMCID: PMC10900230 DOI: 10.3389/fonc.2024.1334156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 01/15/2024] [Indexed: 03/02/2024] Open
Abstract
Background Pulmonary sarcomatoid carcinoma (PSC) is a rare highly aggressive and poorly differentiated non-small cell carcinoma, and little is known about the information on the usefulness of 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT). We investigated the clinical and 18F-FDG PET/CT features of PSC. Methods We retrospectively analyzed 25 consecutive PSC patients who had undergone 18F-FDG PET/CT. Demographic data, PET/CT findings before treatment, pathological features, and prognosis in these patients were investigated to define correlates between maximal standard uptake value (SUVmax) and clinicopathological parameters. Results From March 2017 to January 2023, twenty-five eligible patients with PSC were identified. There were 23 (92%) men, aged 68.5 ± 8.5 (range 56-90) years. Eighteen (72%) patients had a frequent smoking history. The mean size of PSCs was 59.3 ± 18.6 (range 29-97) mm, and 23 (92%) PSCs were Stage IV tumors. 20 (80%) lesions were located in the upper lung and 19 (76%) cases belonged to the peripheral type. Necrotic foci appeared in 21(84%) tumors. 11 (44%) PSCs invaded the pleura. All PSCs were FDG avid, and the mean of SUVmax was 11.8 ± 5.3 (range 4.8-25.5). Metastases were found on PET/CT in 24(96%) patients. The SUVmax of the lesions ≥ 5cm was higher than that of the lesions < 5cm (p=0.004), and the SUVmax of lesions with TTF-1 expression was higher than those of lesions without TTF-1 expression (p=0.009). All of the 25 primary lesions were considered malignant and confirmative, probable, and possible diagnosis of PSC was made in 2 (8%), 4 (16%), and 5(20%) patients, respectively on PET/CT. PSC was not considered in 14 (56%) patients, in PET/CT. The survival of patients with surgery didn't demonstrate a significantly good prognosis as compared with those without surgery (p=0.675). Conclusion All PSCs had obvious FDG avidity. Although imaging diagnosis is still difficult, combined clinical and imaging features more than 40% of primary lesions were considered for the possibility of PSC in our group. Early histopathological diagnosis is necessary to help develop a reasonable regimen.
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Affiliation(s)
- Zhe-Huang Luo
- Department of Nuclear Medicine, Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, China
| | - Xiao-Yan Luo
- Department of Clinical Laboratory, Jiangxi Provincial Children's Hospital, The Affiliated Children's Hospital of Nanchang Medical College, Nanchang, China
| | - Wan-Ling Qi
- Department of Nuclear Medicine, Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, China
| | - Qian Liu
- Department of Pathology, Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, China
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Huang N, Qu T, Zhang C, Li J. Case report: Successful treatment of advanced pulmonary sarcomatoid carcinoma with BUBIB -ALK rearrangement and KRAS G12C mutation by sintilimab combined with anlotinib. Front Oncol 2024; 14:1269148. [PMID: 38414747 PMCID: PMC10896965 DOI: 10.3389/fonc.2024.1269148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Accepted: 01/22/2024] [Indexed: 02/29/2024] Open
Abstract
Pulmonary sarcomatoid carcinoma (PSC) is a rare and aggressive subtype of non-small cell lung cancer (NSCLC) that is characterized by poor differentiation and invasiveness. According to the World Health Organization, PSC exhibits sarcoma or sarcomatoid differentiation and typically presents with an insidious onset, lacking specific symptoms and signs. It is associated with high malignancy, early metastasis, short survival time, and a poor prognosis. Treatment for PSC follows a similar approach to NSCLC; however, it presents significant challenges due to its high resistance to chemotherapy. Previous research has demonstrated the coexistence of two or more target mutations in PSC, and the presence of multiple mutations is correlated with higher mortality rates compared to single mutations. This is supported by our case study of a male patient with advanced BUBIB-ALK rearrangement and KRAS G12C missense mutation. There is currently no standard treatment protocol available for patients with this condition. The patient showed rapid progression after 1 month of alectinib treatment and was intolerant to paclitaxel + cisplatin chemotherapy. Following this, successful disease control was achieved with a combination therapy of sintilimab and anlotinib. The patient achieved a progression-free survival (PFS) of over 20 months, and long-term follow-up is still ongoing for the patient. Based on our clinical experience, the combination of anlotinib and programmed death-1 (PD-1) inhibitors may be a promising strategy for PSC patients, particularly those with multi-target mutations who do not respond to ALK-TKI and are resistant to chemotherapy.
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Affiliation(s)
| | | | - Chunxia Zhang
- Department of Oncology, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Jia Li
- Department of Oncology, The First Affiliated Hospital of Dalian Medical University, Dalian, China
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Wu S, Wu S, Liao X, Zhou C, Qiu F, Wang C, Zhong W. Pembrolizumab combined with anlotinib improves therapeutic efficacy in pulmonary sarcomatoid carcinoma with TMB-H and PD-L1 expression: a case report and literature review. Front Immunol 2023; 14:1274937. [PMID: 37936698 PMCID: PMC10626500 DOI: 10.3389/fimmu.2023.1274937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 09/28/2023] [Indexed: 11/09/2023] Open
Abstract
Background Pulmonary sarcomatoid carcinoma (PSC) is a unique subtype of non-small cell lung cancer (NSCLC) with a high degree of malignancy and poor therapeutic effects. With the widespread use of immune checkpoint inhibitors (ICIs) in recent years, few studies have reported that immunotherapy is effective against PSC. As a multi-target anti-vascular targeting agent, anlotinib showed a better anti-tumor effect in various cancer species. The paper reported the therapeutic and side effects of pembrolizumab combined with anlotinib in a patient with advanced PSC. Case presentation This is a 73 year old female patient who underwent thoracoscopy right upper lobectomy and was diagnosed as locally advanced PSC. However, the patient experienced tumor recurrence and metastasis 7 weeks after surgery and was unable to tolerate chemoradiotherapy. Moreover, she detected TP53 mutation and found that tumor mutation burden (TMB) and PD-L1 were high expression. Therefore, the patient received pembrolizumab combined with anlotinib treatment. After 15 cycles of treatment, the tumor significantly shrank with no tumor activity. The evaluation of tumor efficacy is partial response (PR). During the treatment period, she experienced one-degree thyroid-stimulating hormone elevation and two-degree hand-foot syndrome. Pembrolizumab and anlotinib was continued for two years as a maintenance treatment. The patient had a good quality of life and no disease progression was observed. Currently, the patient is still alive without tumor progression and has overall survival exceeding 45 months and toxic side effects were tolerable. Conclusions Combining ICIs and anti-angiogenic targeted therapy has brought new hope in treating advanced PSC. Additionally, TMB and PD-L1 expression could be potential predictive biomarkers of the efficacy in advanced PSC with immunotherapy.
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Affiliation(s)
- Shugui Wu
- Department of Oncology, The Affiliated Ganzhou Hospital of Nanchang University, Ganzhou, China
- Department of Oncology, Ganzhou Hospital-Nanfang Hospital, Southern Medical University, Ganzhou, China
| | - Shanlian Wu
- Department of Pathology, Ganzhou Hospital-Nanfang Hospital, Southern Medical University, Ganzhou, China
| | - Xiaohong Liao
- Department of Oncology, The Affiliated Ganzhou Hospital of Nanchang University, Ganzhou, China
- Department of Oncology, Ganzhou Hospital-Nanfang Hospital, Southern Medical University, Ganzhou, China
| | - Chaoming Zhou
- Department of Oncology, The Affiliated Ganzhou Hospital of Nanchang University, Ganzhou, China
- Department of Oncology, Ganzhou Hospital-Nanfang Hospital, Southern Medical University, Ganzhou, China
| | - Feng Qiu
- Department of Oncology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Chen Wang
- Department of Oncology, The Affiliated Ganzhou Hospital of Nanchang University, Ganzhou, China
- Department of Oncology, Ganzhou Hospital-Nanfang Hospital, Southern Medical University, Ganzhou, China
| | - Wenjuan Zhong
- Department of Oncology, The First Affiliated Hospital of Gannan Medical University, Ganzhou, China
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Wen Y, Dong Y, Yi L, Yang G, Xiao M, Li Q, Zhao C, Ye D, Yao Y. Anlotinib combined with pembrolizumab as first-line treatment for advanced pulmonary sarcomatoid carcinoma: a case report and literature review. Front Oncol 2023; 13:1241475. [PMID: 37920159 PMCID: PMC10618617 DOI: 10.3389/fonc.2023.1241475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 10/03/2023] [Indexed: 11/04/2023] Open
Abstract
Pulmonary sarcomatoid carcinoma (PSC) is an uncommon variant of non-small cell lung cancer (NSCLC), known for its unfavorable prognosis. Previous studies have elucidated that PSC generally exhibits a significant expression of programmed death-ligand 1 (PD-L1), an elevated tumor mutation burden, and marked vascular invasion. These factors imply the possible effectiveness of treatments like immunotherapy and anti-angiogenic therapy. The subject of this case was a 65-year-old male diagnosed with advanced PSC, characterized by high PD-L1 expression and devoid of known driver gene mutations. Owing to the restrictions imposed by the COVID-19 pandemic, the patient initially underwent home-based treatment with anlotinib, which led to symptomatic improvement after a single treatment cycle. Subsequent hospitalization allowed for the administration of anlotinib plus Pembrolizumab, resulting in a partial response. Radiotherapy was necessitated due to local disease progression. But after 15 cycles of treatment with Pembrolizumab, hyperprogression was observed. The patient's overall survival spanned 14 months, with no evident adverse reactions to the medications. Genomic analysis revealed potential associations between treatment efficacy and mutations in the TP53, NF1, and MET genes. This case underscores the effectiveness and safety of a first-line treatment regimen combining pan-target anti-angiogenic therapy (anlotinib) with anti-tumor immunotherapy.
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Affiliation(s)
- Yingmei Wen
- Cancer Center, Renmin Hospital of Wuhan University, Wuhan, China
| | - Yi Dong
- Cancer Center, Renmin Hospital of Wuhan University, Wuhan, China
| | - Lina Yi
- Cancer Center, Renmin Hospital of Wuhan University, Wuhan, China
| | - Guifang Yang
- Department of Pathology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Mengxia Xiao
- Cancer Center, Renmin Hospital of Wuhan University, Wuhan, China
- Department of Oncology, Yichun People's Hospital, Yichun, China
| | - Qingqing Li
- Cancer Center, Renmin Hospital of Wuhan University, Wuhan, China
| | - Chen Zhao
- Cancer Center, Renmin Hospital of Wuhan University, Wuhan, China
| | - Dafu Ye
- Cancer Center, Renmin Hospital of Wuhan University, Wuhan, China
| | - Yi Yao
- Cancer Center, Renmin Hospital of Wuhan University, Wuhan, China
- Hubei Provincial Research Center for Precision Medicine of Cancer, Wuhan, China
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Zeng Z, Qian X, Liu F, Wang Y, Yuan Y, Fang C, Zhang X, Yuan S, Chen R, Yu B, Wang T, Yin Y, Li Y, Liu A. Corrigendum: The efficacy and safety analysis of first-line immune checkpoint inhibitors in pulmonary sarcomatoid carcinoma. Front Immunol 2023; 14:1269596. [PMID: 37744366 PMCID: PMC10512075 DOI: 10.3389/fimmu.2023.1269596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 08/24/2023] [Indexed: 09/26/2023] Open
Abstract
[This corrects the article DOI: 10.3389/fimmu.2022.956982.].
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Affiliation(s)
- Zhimin Zeng
- Department of Oncology, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
- Jiangxi Key Laboratory of Clinical Translational Cancer Research, Nanchang, Jiangxi, China
- Radiation Induced Heart Damage Institute of Nanchang University, Nanchang, Jiangxi, China
| | - Xiaoying Qian
- Department of Medical Oncology, The First Affiliated Hospital of Nanchang University, Nanchang, China
- Medical Innovation Center, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Fanrong Liu
- Department of Pathology, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yong Wang
- Department of Medical Oncology, The First Affiliated Hospital of Nanchang University, Nanchang, China
- Medical Innovation Center, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yong Yuan
- Department of Thoracic Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Chen Fang
- Department of Medical Oncology, The First Affiliated Hospital of Nanchang University, Nanchang, China
- Medical Innovation Center, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Xinwei Zhang
- Department of Medical Oncology, The First Affiliated Hospital of Nanchang University, Nanchang, China
- Medical Innovation Center, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Shangkun Yuan
- Department of Medical Oncology, The First Affiliated Hospital of Nanchang University, Nanchang, China
- Medical Innovation Center, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Renfang Chen
- Department of Medical Oncology, The First Affiliated Hospital of Nanchang University, Nanchang, China
- Medical Innovation Center, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Biao Yu
- Department of Medical Oncology, The First Affiliated Hospital of Nanchang University, Nanchang, China
- Medical Innovation Center, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Tong Wang
- Department of Medical Oncology, The First Affiliated Hospital of Nanchang University, Nanchang, China
- Medical Innovation Center, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yan Yin
- Department of Pathology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yong Li
- Department of Medical Oncology, The First Affiliated Hospital of Nanchang University, Nanchang, China
- Medical Innovation Center, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Anwen Liu
- Department of Oncology, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
- Jiangxi Key Laboratory of Clinical Translational Cancer Research, Nanchang, Jiangxi, China
- Radiation Induced Heart Damage Institute of Nanchang University, Nanchang, Jiangxi, China
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Qin H, Wan Y, Dong Y, Sun Q. A Metastatic Pulmonary Sarcomatoid Carcinoma Patient Harboring KIF5B-RET Fusion Responds to First-Line Pralsetinib Treatment: A Case Report. Cancer Manag Res 2023; 15:765-769. [PMID: 37525669 PMCID: PMC10387260 DOI: 10.2147/cmar.s414077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 07/10/2023] [Indexed: 08/02/2023] Open
Abstract
Pulmonary sarcomatoid carcinoma (PSC) is a rare subtype of non-small cell lung cancer (NSCLC), accounting for about 1% of cases. These tumors are characterized by their high malignancy and frequent resistance to chemotherapy, resulting in a worse prognosis compared to other NSCLC subtypes. Currently, there is no established therapeutic strategy for PSC. Recent advancements in targeted therapies have led to the development of ret proto-oncogene (RET) inhibitors, such as selpercatinib and pralsetinib, which have been approved for the treatment of RET fusion-positive NSCLC patients. Despite their effectiveness in RET fusion-positive NSCLC is observed, the efficacy of these inhibitors in PSC remains unclear. In this context, we present a case of metastatic PSC harboring de novo KIF5B-RET fusion. The patient responded to first-line trametinib treatment. These findings suggest that RET inhibitors could be a potential treatment option for metastatic PSC patients with RET fusion-positive tumors.
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Affiliation(s)
- Hao Qin
- Department of Respiratory and Critical Care Medicine, Shanghai Changhai Hospital, The First Affiliated Hospital of Second Military Medical University, Shanghai, People’s Republic of China
| | - Yuxiang Wan
- Department of Laboratory Diagnosis, Shanghai Changhai Hospital, The First Affiliated Hospital of Second Military Medical University, Shanghai, People’s Republic of China
| | - Yuchao Dong
- Department of Respiratory and Critical Care Medicine, Shanghai Changhai Hospital, The First Affiliated Hospital of Second Military Medical University, Shanghai, People’s Republic of China
| | - Qinying Sun
- Department of Respiratory and Critical Care Medicine, Shanghai Changhai Hospital, The First Affiliated Hospital of Second Military Medical University, Shanghai, People’s Republic of China
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Fang R, Gong J, Liao Z. An advanced pulmonary sarcomatoid carcinoma patient harboring a BRAF V600E mutation responds to dabrafenib and trametinib: a case report and literature review. Front Oncol 2023; 13:1220745. [PMID: 37546400 PMCID: PMC10403232 DOI: 10.3389/fonc.2023.1220745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 06/28/2023] [Indexed: 08/08/2023] Open
Abstract
Background The pulmonary sarcomatoid carcinoma (PSC) is a rare and aggressive subtype of NSCLC with rapid progression and poor prognosis, and is resistant to conventional chemotherapy. Most PSC cases have potential targetable genomic alterations. Approximately 7% of PSC patients have BRAF mutations, and the efficacy of dabrafenib and trametinib in BRAFV600E mutated PSC is unclear. Case presentation Our report describes a patient with mutated BRAFV600E PSC who underwent surgery and adjuvant chemotherapy early but quickly relapsed. Both chemotherapy and immunotherapy were ineffective for him, combined dabrafenib and trametinib produced a 6-month progression-free survival, and a partial response was observed in the tumor response evaluation. As a result of financial pressure, he stopped taking the targeted drugs, and his disease rapidly progressed. Conclusion Dabrafenib combined with trametinib provides partial remission in patients with advanced PSC with BRAFV600E mutations, and large-scale NGS panels could offer more options for PSC treatment.
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Dai G, He L, Yan Q, Li Y, Huang Y, Li B, Wang G. Case Report: Advanced pulmonary sarcomatoid carcinoma with adrenal gland metastasis after sintilimab combined with anlotinib treatment. Front Oncol 2023; 13:1167516. [PMID: 37456237 PMCID: PMC10348826 DOI: 10.3389/fonc.2023.1167516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 06/09/2023] [Indexed: 07/18/2023] Open
Abstract
Background Pulmonary sarcomatoid carcinoma (PSC) is a rare subtype of non-small-cell lung cancer (NSCLC), which is resistant to conventional chemotherapy and radiotherapy with a poor prognosis. The MET inhibitor may be effective for the patients with MET exon 14 skipping mutation. This mutation was not detected in this patient. However, the PD-L1 TPS 60%, KRAS and TP53 mutations were detected in this patient could benefited from immunotherapy. The anlotinib is a novel multitarget antiangiogenic drug that could be effective for advanced non-small-cell lung cancer and some sarcoma patients. We report a patient with advanced pulmonary sarcomatoid carcinoma successfully treated with immunotherapy combined with antiangiogenic drugs. Case summary A 75-year-old male was admitted to the hospital in July 2020 because of productive cough for more than three months. The patient was diagnosed with advanced pulmonary sarcomatoid carcinoma with adrenal gland metastasis (cT4N3M1b, stage IVA) was treated in our hospital. Genetic testing revealed KRAS P.L19F mutation (abundance 19.12%) and NFEE2L2 P.E82G mutation (abundance 14.84%); TP53 P.S183 mutation (abundance 26.97%), TMB(Tumor Mutational Burden) 30.91 muts/Mb, MSS, and PD-L1 (Daco 22C3) TPS 60% were also detected. We administrated sintilimab combined with anlotinib treatment, a PD-1 inhibitor with antiangiogenic drug. The patient achieved a favorable outcome with tolerable adverse effects. Conclusion Sintilimab combined with anlotinib treatment may lead to a favorable outcome for patients with advanced pulmonary sarcomatoid carcinoma.
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Affiliation(s)
- Gangyi Dai
- Department of Oncology, the Chengdu Fifth People’s Hospital, Chengdu, Sichuan, China
- Affiliated Chengdu Fifth People’s Hospital of Chengdu University of Traditional Chinese Medicine (Second Clinical Medical School), Chengdu Institute of Cancer Prevention and Control, Chengdu, Sichuan, China
| | - Lang He
- Department of Oncology, the Chengdu Fifth People’s Hospital, Chengdu, Sichuan, China
- Affiliated Chengdu Fifth People’s Hospital of Chengdu University of Traditional Chinese Medicine (Second Clinical Medical School), Chengdu Institute of Cancer Prevention and Control, Chengdu, Sichuan, China
| | - Qin Yan
- Department of Oncology, the Chengdu Fifth People’s Hospital, Chengdu, Sichuan, China
- Affiliated Chengdu Fifth People’s Hospital of Chengdu University of Traditional Chinese Medicine (Second Clinical Medical School), Chengdu Institute of Cancer Prevention and Control, Chengdu, Sichuan, China
| | - Yamao Li
- Department of Oncology, the Chengdu Fifth People’s Hospital, Chengdu, Sichuan, China
- Affiliated Chengdu Fifth People’s Hospital of Chengdu University of Traditional Chinese Medicine (Second Clinical Medical School), Chengdu Institute of Cancer Prevention and Control, Chengdu, Sichuan, China
| | - Yuandong Huang
- Department of Oncology, the Chengdu Fifth People’s Hospital, Chengdu, Sichuan, China
- Affiliated Chengdu Fifth People’s Hospital of Chengdu University of Traditional Chinese Medicine (Second Clinical Medical School), Chengdu Institute of Cancer Prevention and Control, Chengdu, Sichuan, China
| | - Bin Li
- Department of Oncology, the Chengdu Fifth People’s Hospital, Chengdu, Sichuan, China
- Affiliated Chengdu Fifth People’s Hospital of Chengdu University of Traditional Chinese Medicine (Second Clinical Medical School), Chengdu Institute of Cancer Prevention and Control, Chengdu, Sichuan, China
| | - Guoping Wang
- Department of Oncology, the Chengdu Fifth People’s Hospital, Chengdu, Sichuan, China
- Affiliated Chengdu Fifth People’s Hospital of Chengdu University of Traditional Chinese Medicine (Second Clinical Medical School), Chengdu Institute of Cancer Prevention and Control, Chengdu, Sichuan, China
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Stephan-Falkenau S, Streubel A, Mairinger T, Blum TG, Kollmeier J, Mairinger FD, Bauer T, Pfannschmidt J, Hollmann M, Wessolly M. Integrated Clinical, Molecular and Immunological Characterization of Pulmonary Sarcomatoid Carcinomas Reveals an Immune Escape Mechanism That May Influence Therapeutic Strategies. Int J Mol Sci 2023; 24:10558. [PMID: 37445733 DOI: 10.3390/ijms241310558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 06/16/2023] [Accepted: 06/21/2023] [Indexed: 07/15/2023] Open
Abstract
Pulmonary sarcomatoid carcinoma (PSC) has highly aggressive biological behaviour and poor clinical outcomes, raising expectations for new therapeutic strategies. We characterized 179 PSC by immunohistochemistry, next-generation sequencing and in silico analysis using a deep learning algorithm with respect to clinical, immunological and molecular features. PSC was more common in men, older ages and smokers. Surgery was an independent factor (p < 0.01) of overall survival (OS). PD-L1 expression was detected in 82.1% of all patients. PSC patients displaying altered epitopes due to processing mutations showed another PD-L1-independent immune escape mechanism, which also significantly influenced OS (p < 0.02). The effect was also maintained when only advanced tumour stages were considered (p < 0.01). These patients also showed improved survival with a significant correlation for immunotherapy (p < 0.05) when few or no processing mutations were detected, although this should be interpreted with caution due to the small number of patients studied. Genomic alterations for which there are already approved drugs were present in 35.4% of patients. Met exon 14 skipping was found more frequently (13.7%) and EGFR mutations less frequently (1.7%) than in other NSCLC. In summary, in addition to the divergent genomic landscape of PSC, the specific immunological features of this prognostically poor subtype should be considered in therapy stratification.
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Affiliation(s)
- Susann Stephan-Falkenau
- Institute for Tissue Diagnostics, MVZ at Helios Klinikum Emil von Behring, 14165 Berlin, Germany
| | - Anna Streubel
- Institute for Tissue Diagnostics, MVZ at Helios Klinikum Emil von Behring, 14165 Berlin, Germany
| | - Thomas Mairinger
- Institute for Tissue Diagnostics, MVZ at Helios Klinikum Emil von Behring, 14165 Berlin, Germany
| | - Torsten-Gerriet Blum
- Department of Pneumology, Heckeshorn Lung Clinic, Helios Klinikum Emil von Behring, 14165 Berlin, Germany
| | - Jens Kollmeier
- Department of Pneumology, Heckeshorn Lung Clinic, Helios Klinikum Emil von Behring, 14165 Berlin, Germany
| | - Fabian D Mairinger
- Institute of Pathology, University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany
- German Cancer Consortium (DKTK), Partner Site University Hospital Essen, 45147 Essen, Germany
| | - Torsten Bauer
- Department of Pneumology, Heckeshorn Lung Clinic, Helios Klinikum Emil von Behring, 14165 Berlin, Germany
| | - Joachim Pfannschmidt
- Department of Thoracic Surgery, Heckeshorn Lung Clinic, Helios Klinikum Emil von Behring, 14165 Berlin, Germany
| | - Manuel Hollmann
- Institute for Tissue Diagnostics, MVZ at Helios Klinikum Emil von Behring, 14165 Berlin, Germany
| | - Michael Wessolly
- Institute of Pathology, University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany
- German Cancer Consortium (DKTK), Partner Site University Hospital Essen, 45147 Essen, Germany
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Sun W, Wang X, Shi Q, Li X, Chen C. Comprehensive treatment for ROS1-overexpressed pulmonary sarcomatoid carcinoma: A case report. Clin Case Rep 2023; 11:e7365. [PMID: 37215977 PMCID: PMC10196425 DOI: 10.1002/ccr3.7365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 04/28/2023] [Accepted: 05/04/2023] [Indexed: 05/24/2023] Open
Abstract
Key Clinical Message In conclusion author highlights the tumor cell genetic testing or molecular pathological diagnosis plays a key role in the individualized treatment of PSC, which could benefit patients with advanced PSC. Abstract An uncommon form of non-small-cell lung cancer (NSCLC) with a poor prognosis is pulmonary sarcomatoid carcinoma (PSC). Surgical resection is currently the preferred treatment, but guidelines for adjuvant chemotherapy have not yet been established, especially for the advanced stage. The development of molecular subgroups in the field of tumors may be advantageous to advanced PSC patients with the ongoing progress of genomics and immunology. A 54-year-old man presented to Xishan People's Hospital of Wuxi City with recurrent intermittent dry cough with fever for 1 month. Further examinations suggested the diagnosis of PSC occupying almost the entire right interlobar fissure area combined with malignant pleural effusion (Stage IVa). Pathological examination confirmed the diagnosis of PSC with ROS1 overexpressing via genetic testing. However, after three cycles of chemo-, antiangiogenetic- and immunochemical therapy, the lesion was localized, and pleural effusion disappeared, the patient subsequently received an operation which was performed as R0 resection. Unfortunately, the patient became deteriorated quickly followed by extensive metastatic nodules in the thoracic cavity. Although the patient continued to receive chemo- and immunochemical-therapy, it did not limit the progress of the tumor, leading to widespread metastasis, and eventually died of multiple organ failure. For PSC patients with Stage IVa, chemo-, antiangiogenetic- and immunochemical-therapy performs well in clinical efficacy, and comprehensive panel-based genetic testing may offer PSC patients a somewhat better prognosis. However, blindly implementing surgical treatment may bring harm to the patient and affect long-term survival. It's essential to know the surgical indications precisely by NSCLC guidelines.
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Affiliation(s)
- Wei Sun
- Department of Respiratory and Critical CareXishan People's Hospital of Wuxi CityWuxiChina
| | - Xinlian Wang
- Department of Cardiothoracic SurgeryXishan People's Hospital of Wuxi CityWuxiChina
| | - Qifeng Shi
- Department of PathologyXishan People's Hospital of Wuxi CityWuxiChina
| | - Xiao Li
- Department of Pathologythe First Affiliated Hospital of Nanjing Medical UniversityNanjingChina
| | - Chaobo Chen
- Department of General SurgeryXishan People's Hospital of Wuxi CityWuxiChina
- Department of Hepatic‐Biliary‐Pancreatic SurgeryThe Affiliated Drum Tower Hospital of Nanjing University Medical schoolNanjingChina
- Department of Immunology, Ophthalmology & ORLComplutense University School of MedicineMadridSpain
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Ullah A, Ahmed A, Yasinzai AQK, Lee KT, Khan I, Asif B, Khan I, Tareen B, Kakar K, Andam G, Heneidi S, Khan J, Khan H, Karki NR, Del Rivero J, Karim NA. Demographics and Clinicopathologic Profile of Pulmonary Sarcomatoid Carcinoma with Survival Analysis and Genomic Landscape. Cancers (Basel) 2023; 15:cancers15092469. [PMID: 37173936 PMCID: PMC10177027 DOI: 10.3390/cancers15092469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 04/20/2023] [Accepted: 04/24/2023] [Indexed: 05/15/2023] Open
Abstract
Background: Pulmonary sarcomatoid carcinoma (PSC) is a rare subtype of non-small cell lung cancer (NSCLC) with an aggressive clinical nature and poor prognosis. With novel targeted therapeutics being developed, new ways to effectively treat PSC are emerging. In this study, we analyze demographics, tumor characteristics, treatment modalities, and outcomes of PSC and genetic mutations in PSC. Methods: Data from the Surveillance, Epidemiology, and End Results (SEER) database were reviewed to analyze cases of pulmonary sarcomatoid carcinoma from 2000 to 2018. The molecular data with the most common mutations in PSC were extracted from the Catalogue Of Somatic Mutations in Cancer (COSMIC) database. Results: A total of 5259 patients with PSC were identified. Most patients were between 70 and 79 years of age (32.2%), male (59.1%), and Caucasian (83.7%). The male-to-female ratio was 1.45:1. Most tumors were between 1 and 7 cm in size (69.4%) and poorly differentiated (grade III) (72.9%). The overall 5-year survival was 15.6% (95% confidence interval (95% CI) = 14.4-16.9)), and the cause-specific 5-year survival was 19.7% (95% CI = 18.3-21.1). The five-year survival for those treated with each modality were as follows: chemotherapy, 19.9% (95% CI = 17.7-22.2); surgery, 41.7% (95% CI = 38.9-44.6); radiation, 19.1% (95% CI = 15.1-23.5); and multimodality therapy (surgery and chemoradiation), 24.8% (95% CI = 17.6-32.7). On multivariable analysis, age, male gender, distant stage, tumor size, bone metastasis, brain metastasis, and liver metastasis were associated with increased mortality, and chemotherapy and surgery were associated with reduced mortality (p < 0.001). The best survival outcomes were achieved with surgery. The most common mutations identified in COSMIC data were TP53 31%, ARID1A 23%, NF1 17%, SMARCA4 16%, and KMT2D 9%. Conclusions: PSC is a rare and aggressive subtype of NSCLC, usually affecting Caucasian males between 70 and 79. Male gender, older age, and distant spread were associated with poor clinical outcomes. Treatment with surgery was associated with better survival outcomes.
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Affiliation(s)
- Asad Ullah
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University, Nashville, TN 37232, USA
| | - Asim Ahmed
- Medical College of Georgia, Augusta, GA 30912, USA
| | | | | | - Israr Khan
- Hackensack Meridian Health, Palisades Medical Center, North Bergen, NJ 07047, USA
| | - Bina Asif
- Bannu Medical College, Bannu 28100, Pakistan
| | - Imran Khan
- Department of Medicine, Bolan Medical College, Quetta 83700, Pakistan
| | - Bisma Tareen
- Department of Medicine, Bolan Medical College, Quetta 83700, Pakistan
| | - Kaleemullah Kakar
- Department of Medicine, Bolan Medical College, Quetta 83700, Pakistan
| | - Gul Andam
- Department of Medicine, Bolan Medical College, Quetta 83700, Pakistan
| | - Saleh Heneidi
- Department of Pathology, Cedars Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Jaffar Khan
- Department of Pathology, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Hina Khan
- Division of Hematology and Oncology, Warren Alpert Medical School of Brown University, Providence, RI 02912, USA
| | - Nabin R Karki
- Mitchell Cancer Institute, University of South Alabama, Mobile, AL 36604, USA
| | | | - Nagla Abdel Karim
- Inova Schar Cancer Institute, University of Virginia, Fairfax, VA 22031, USA
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Liu X, Zheng Y, Mai S, Tong Y, Yang L, Huang M, Cai R. Case report: an initially unresectable stage III pulmonary sarcomatoid carcinoma qith EGFR mutation achieving pathological complete response following neoadjuvant therapy with osimertinib plus chemotherapy. Front Oncol 2022; 12:1033322. [PMID: 36505870 PMCID: PMC9733669 DOI: 10.3389/fonc.2022.1033322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 11/07/2022] [Indexed: 11/27/2022] Open
Abstract
Epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (EGFR-TKIs) provide dramatic response to patients with advanced EGFR-mutant non-small cell lung cancer (NSCLC). However, the use of neoadjuvant therapy with EGFR-TKIs in EGFR-mutant NSCLC remains controversial, especially in pulmonary sarcomatoid carcinoma (PSC). One patient with initially unresectable stage III (cT4N0M0) PSC was found to carry EGFR mutation by the next generation sequencing. After neoadjuvant therapy with osimertinib plus chemotherapy, radical resection of the right upper lung lesion was achieved, and the pathological results reached pathological complete response (pCR). To the best of our knowledge, this is the first report of an EGFR-mutant patient with initially unresectable stage III PSC achieved pCR by neoadjuvant therapy with osimertinib plus chemotherapy. Therefore, neoadjuvant therapy with EGFR-TKIs may be a viable option for EGFR-mutant PSC patients.
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Affiliation(s)
- Xiguang Liu
- Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Yating Zheng
- Medical Department, 3D Medicines Inc., Shanghai, China
| | - Shijie Mai
- Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Yu Tong
- Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Lili Yang
- Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Mengli Huang
- Medical Department, 3D Medicines Inc., Shanghai, China
| | - Ruijun Cai
- Nanfang Hospital, Southern Medical University, Guangzhou, China,*Correspondence: Ruijun Cai,
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Huang L, Huang T, Li L, Feng A, He N, Li S, Lyu J. Factors Associated With Lymph Node Yield and Effects of Lymph Node Density on Survival of Patients With Pulmonary Sarcomatoid Carcinoma. Am J Clin Oncol 2022; 45:458-64. [PMID: 36256867 DOI: 10.1097/COC.0000000000000946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE The objective of this study was to identify factors associated with lymph node yield (LNY) during surgeries for pulmonary sarcomatoid carcinoma (PSC) and to determine effects of lymph node density (LND) on the overall survival (OS) of patients with PSC. MATERIALS AND METHODS The SEER Research Plus database was searched for data on patients with PSC from 1988 to 2018. Poisson regression was used of all patients with PSC to identify relevant factors associated with LNY. Univariate and multivariate Cox regression analyses were adopted for lymph node (LN)-positive patients to evaluate the impact of LND on OS. The 5-year OS rates of patients with PSC were compared based on their LN status and LND. RESULTS There were 545 eligible patients in the study sample, 175 of which were LN-positive. These patients had significantly lower 5-year OS than those with no positive LNs ( P <0.001). Poisson regression analysis indicated relevant factors increasing LNY included higher diagnosis age, non-Hispanic American Indian or Alaska Native races, larger tumor, pleomorphic carcinoma histology, and more advanced disease stages. The Cox regression analysis indicated higher LND ( P =0.022) was probably associated with a worse prognosis for LN-positive patients. The group with LND ≥0.12 had a higher risk of death than the group with LND <0.12 ( P <0.001) among LN-positive patients with PSC. CONCLUSIONS Patients with PSC with high LND experienced worse outcomes than those with low LND. Further risk stratification of patients with PSC may help to improve survival benefits based on prognostic indicators of LND.
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Yu Y, Ren Y, Fang J, Cao L, Liang Z, Guo Q, Han S, Ji Z, Wang Y, Sun Y, Chen Y, Li X, Xu H, Zhou J, Jiang L, Cheng Y, Han Z, Shi J, Chen G, Ma R, Fan Y, Sun S, Jiao L, Jia X, Wang L, Lu P, Xu Q, Luo X, Su W, Lu S. Circulating tumour DNA biomarkers in savolitinib-treated patients with non-small cell lung cancer harbouring MET exon 14 skipping alterations: a post hoc analysis of a pivotal phase 2 study. Ther Adv Med Oncol 2022; 14:17588359221133546. [PMID: 36339926 PMCID: PMC9629582 DOI: 10.1177/17588359221133546] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 09/27/2022] [Indexed: 11/11/2022] Open
Abstract
Background Savolitinib, a selective MET inhibitor, showed efficacy in patients with non-small cell lung cancer (NSCLC), including pulmonary sarcomatoid carcinoma (PSC), harbouring MET exon 14 skipping alteration (METex14). Objective To analyse post hoc, the association between circulating tumour DNA (ctDNA) biomarkers and clinical outcomes, including resistance, with savolitinib. Design A multicentre, single-arm, open-label phase 2 study. Methods All enrolled patients with baseline plasma samples were included. Outcomes were objective response rate (ORR), progression-free survival (PFS) and overall survival (OS) by baseline METex14 and post-treatment clearance, coexisting gene alterations at baseline and disease progression. Results Among 66 patients with baseline ctDNA sequencing, 46 (70%) had detectable METex14. Frequent coexisting baseline gene alterations included TP53 and POT1 mutations. Patients with detectable baseline METex14 exhibited worse PFS [hazard ratio (HR), 1.77; 95% confidence interval (CI), 0.88-3.57; p = 0.108] and OS (HR, 3.26; 95% CI, 1.35-7.89; p = 0.006) than those without, despite showing a numerically higher ORR. Among 24 patients with baseline detectable METex14 and evaluable postbaseline samples, 13 achieved METex14 clearance post-treatment. Median time to first clearance was 1.3 months (range, 0.7-1.5). METex14 post-treatment clearance was associated with better ORR (92.3%; 95% CI, 64.0-99.8 versus 36.4%; 95% CI, 10.9-69.2; p = 0.0078), PFS (HR, 0.44; 95% CI, 0.2-1.3; p = 0.1225) and OS (HR, 0.31; 95% CI, 0.1-1.0; p = 0.0397) versus non-clearance. Among 22 patients with disease progression, 10 acquired pathway alterations (e.g. in RAS/RAF and PI3K/PTEN) alone or with secondary MET mutations (D1228H/N and Y1230C/H/S). Conclusion ctDNA biomarkers may allow for longitudinal monitoring of clinical outcomes with savolitinib in patients with METex14-positive PSC and other NSCLC subtypes. Specifically, undetectable baseline METex14 or post-treatment clearance may predict favourable clinical outcomes, while secondary MET mutations and other acquired gene alterations may explain resistance to savolitinib. Registration The trial was registered with ClinicalTrials.gov (NCT02897479) on 13 September 2016.
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Affiliation(s)
- Yongfeng Yu
- Department of Medical Oncology, Shanghai Chest
Hospital, Shanghai Jiaotong University, Shanghai, China
| | | | - Jian Fang
- Peking University Cancer Hospital and
Institute, Beijing, China
| | - Lejie Cao
- Anhui Provincial Hospital, The First Affiliated
Hospital of University of Science and Technology of China, Hefei,
China
| | - Zongan Liang
- West China Hospital of Sichuan University,
Chengdu, China
| | - Qisen Guo
- Shandong Cancer Hospital Affiliated to Shandong
University, Jinan, China
| | - Sen Han
- Peking University Cancer Hospital and
Institute, Beijing, China
| | - Zimei Ji
- Anhui Provincial Hospital, The First Affiliated
Hospital of University of Science and Technology of China, Hefei,
China
| | - Ye Wang
- West China Hospital of Sichuan University,
Chengdu, China
| | - Yulan Sun
- Shandong Cancer Hospital Affiliated to
Shandong University, Jinan, China
| | - Yuan Chen
- Tongji Hospital, Huazhong University of
Science and Technology, Wuhan, China
| | - Xingya Li
- The First Affiliated Hospital of Zhengzhou
University, Zhengzhou, China
| | - Hua Xu
- The Second Affiliated Hospital of Nanchang
University, Nanchang, China
| | - Jianying Zhou
- The First Affiliated Hospital of Zhejiang
University, Hangzhou, China
| | - Liyan Jiang
- Department of Medical Oncology, Shanghai Chest
Hospital, Shanghai Jiaotong University, Shanghai, China
| | | | - Zhigang Han
- The Affiliated Cancer Hospital of Xinjiang
Medical University, Urumqi, China
| | | | - Gongyan Chen
- Cancer Hospital of Harbin Medical University,
Harbin, China
| | - Rui Ma
- Liaoning Cancer Hospital, Shenyang,
China
| | - Yun Fan
- Zhejiang Cancer Hospital, Hangzhou,
China
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Zeng Z, Qian X, Liu F, Wang Y, Yuan Y, Fang C, Zhang X, Yuan S, Chen R, Yu B, Wang T, Yin Y, Li Y, Liu A. The efficacy and safety analysis of first-line immune checkpoint inhibitors in pulmonary sarcomatoid carcinoma. Front Immunol 2022; 13:956982. [PMID: 36389780 PMCID: PMC9659892 DOI: 10.3389/fimmu.2022.956982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 10/04/2022] [Indexed: 09/26/2023] Open
Abstract
Background Pulmonary sarcomatoid carcinoma (PSC) is a rare and aggressive disease without standardized treatment strategies. The efficacy of second-line or beyond immune checkpoint inhibitors (ICIs) has been proven in recent studies, whereas the evidence for first-line immunotherapy for PSC is still limited to case reports and remains poorly understood. Materials and methods This was a multicenter, retrospective analysis of 21 patients with a histological diagnosis of PSC who received ICI as first-line therapy from January 2019 to March 2022. The expression of PD-L1 was evaluated by immunohistochemistry (IHC) using the monoclonal antibody 22C3. Low and high PD-L1 expressions were defined using the tumor proportion score (TPS), with cutoffs of 1 and 50%, respectively. Results All eight patients had PD-L1 positivity who underwent PD-L1 expression assessment, and six patients (6/8, 75.0%) had high PD-L1 expression. Among the 21 PSC patients, seven received tislelizumab, six received camrelizumab, four received sintilimab, three received pembrolizumab, and one received durvalumab. Among them, 18 PSCs received combination therapy, whereas another three PSCs received immunotherapy alone. Out of the 21 PSC patients, 12 (57.1%) achieved a partial response (PR), and five patients had stable disease (SD) as the best response, whereas four PSCs experienced dramatic progressive disease (PD). The median progression-free survival (PFS) was 9.2 (95% CI [4.3, 14.1]) months, and the median OS was 22.8 (95% CI [4.0, 41.5]) months. Among the three treatment groups (immunotherapy alone, immunotherapy combined with anlotinib, and chemoimmunotherapy), the median PFS was 8.0, 9.4, and 9.6 months, and the median OS was 19.0, 22.8, and 30.6 months, respectively. There was no difference in PFS and OS between the three treatment regimen groups (P = 0.86 and P = 0.34, respectively) and different immunotherapies (P = 0.10 and P = 0.23, respectively). No serious adverse events (grade ≥ 3) were noted. Conclusion First-line immunotherapy has promising therapeutic potential in the treatment of PSC. More studies are warranted to confirm these findings.
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Affiliation(s)
- Zhimin Zeng
- Department of Oncology, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
- Jiangxi Key Laboratory of Clinical Translational Cancer Research, Nanchang, Jiangxi, China
- Radiation Induced Heart Damage Institute of Nanchang University, Nanchang, Jiangxi, China
| | - Xiaoying Qian
- Department of Medical Oncology, The First Affiliated Hospital of Nanchang University, Nanchang, China
- Medical Innovation Center, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Fanrong Liu
- Department of Pathology, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yong Wang
- Department of Medical Oncology, The First Affiliated Hospital of Nanchang University, Nanchang, China
- Medical Innovation Center, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yong Yuan
- Department of Thoracic Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Chen Fang
- Department of Medical Oncology, The First Affiliated Hospital of Nanchang University, Nanchang, China
- Medical Innovation Center, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Xinwei Zhang
- Department of Medical Oncology, The First Affiliated Hospital of Nanchang University, Nanchang, China
- Medical Innovation Center, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Shangkun Yuan
- Department of Medical Oncology, The First Affiliated Hospital of Nanchang University, Nanchang, China
- Medical Innovation Center, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Renfang Chen
- Department of Medical Oncology, The First Affiliated Hospital of Nanchang University, Nanchang, China
- Medical Innovation Center, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Biao Yu
- Department of Medical Oncology, The First Affiliated Hospital of Nanchang University, Nanchang, China
- Medical Innovation Center, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Tong Wang
- Department of Medical Oncology, The First Affiliated Hospital of Nanchang University, Nanchang, China
- Medical Innovation Center, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yan Yin
- Department of Pathology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yong Li
- Department of Medical Oncology, The First Affiliated Hospital of Nanchang University, Nanchang, China
- Medical Innovation Center, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Anwen Liu
- Department of Oncology, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
- Jiangxi Key Laboratory of Clinical Translational Cancer Research, Nanchang, Jiangxi, China
- Radiation Induced Heart Damage Institute of Nanchang University, Nanchang, Jiangxi, China
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Chang CL, Hsieh MS, Shih JY, Lee YH, Liao WY, Hsu CL, Yang CY, Chen KY, Lee JH, Ho CC, Tsai TH, Yang JCH, Yu CJ. Real-world treatment patterns and outcomes among patients with advanced non-small-cell lung cancer with spindle cell and/or giant cell carcinoma. Ther Adv Med Oncol 2022; 14:17588359221133889. [PMID: 36324732 PMCID: PMC9618761 DOI: 10.1177/17588359221133889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 10/03/2022] [Indexed: 11/06/2022] Open
Abstract
Objectives A definitive diagnosis of pulmonary sarcomatoid carcinoma cannot be made with small biopsies. In clinical practice, a diagnosis of advanced non-small-cell lung cancer with spindle cell and/or giant cell carcinoma (NSCLCsg), or possible sarcomatoid carcinoma, is acceptable. Therefore, we aimed to investigate the treatment patterns and outcomes of advanced NSCLCsg. Materials and methods Between 01 January 2012 and 01 April 2021, patients with pathologically proven advanced NSCLCsg were enrolled. The choice of treatment was based on clinician discretion. Results In all, 101 patients with advanced NSCLCsg were enrolled. In total, 77 (76.2%) patients received at least one line of systemic therapy; 44 patients (43.1%) had received platinum doublet chemotherapy; 27 (26.7%) patients had been treated with targeted therapies; and 23 patients (22.8%) had been given an immune checkpoint inhibitor (ICI). The median overall survival (OS) was 6.3 months [95% confidence interval (CI): 3.6-9.0 months]. Excluding patients without systemic therapy, patients who had received an ICI had better OS (median: 18.2 months) than those who had not (median 3.8 months, log-rank test p = 0.002). No significant difference in OS was detected between patients who had or had not received platinum doublet chemotherapy (log-rank test p = 0.279), or targeted therapy (log-rank test p = 0.416). Having received any systemic therapy [hazard ratio (HR): 0.33, 95% CI: 0.18-0.61, p < 0.0001) and ICI (HR: 0.38, 95% CI: 0.19-0.78, p = 0.008) were independent factors for better OS. Patients with programmed death ligand-1 (PD-L1) expression ⩾50% had better OS than those with PD-L1 expression <50% (HR: 0.51, 95%: 0.30-0.86, p = 0.012). Conclusion Although advanced NSCLCsg has a poor survival outcome, our results showed that ICI may prolong OS in patients with advanced NSCLCsg. Further prospective studies are warranted to gain more understanding of the role of ICI in this specific patient population.
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Affiliation(s)
- Chia-Ling Chang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, National Taiwan University Hospital, Hsin-Chu Branch, and National Taiwan University College of Medicine
| | - Min-Shu Hsieh
- Department of Pathology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei,Graduate Institute of Pathology, National Taiwan University College of Medicine, Taipei
| | - Jin-Yuan Shih
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei
| | - Yi-Hsuan Lee
- Department of Pathology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei,Graduate Institute of Pathology, National Taiwan University College of Medicine, Taipei
| | | | - Chia-Lin Hsu
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei
| | - Ching-Yao Yang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei
| | - Kuan-Yu Chen
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei
| | - Jih-Hsiang Lee
- Department of Oncology, National Taiwan University Hospital, Hsin-Chu Branch, and National Taiwan University College of Medicine
| | - Chao-Chi Ho
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei
| | - Tzu-Hsiu Tsai
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei
| | - James Chih-Hsin Yang
- Department of Oncology, National Taiwan University Cancer Center and National Taiwan University College of Medicine, Taipei
| | - Chong-Jen Yu
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, National Taiwan University Hospital, Hsin-Chu Branch, and National Taiwan University College of Medicine
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20
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Nian J, Zhu Y, Fu Q, Yang G, Wang X. Significant response of pulmonary sarcomatoid carcinoma with obstructive atelectasis to treatment with the PD-1 inhibitor camrelizumab combined with transbronchial cryoablation: A case report and literature review. Front Oncol 2022; 12:1013047. [PMID: 36387200 PMCID: PMC9646958 DOI: 10.3389/fonc.2022.1013047] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 10/17/2022] [Indexed: 08/08/2023] Open
Abstract
Pulmonary sarcomatoid carcinoma (PSC) is a rare subtype of non-small cell lung cancer with high malignancy and poor prognosis. Chemotherapy or radiotherapy do not usually provide satisfactory results in patients with PSC, especially in those with advanced-stage cancer. Targeted therapy and immunotherapy are more precise therapies that may be effective in the treatment of PSC; however, further research is needed. Here, we present a case of stage III PSC with obstructive atelectasis, which is more challenging and hinders treatment. Treatment with the PD-1 inhibitor camrelizumab and transbronchial cryoablation showed significant clinical efficacy. This type of combined treatment has not been reported previously for PSC. Thus, this case may provide a valuable reference for future clinical practice and research.
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Affiliation(s)
| | - Yong Zhu
- *Correspondence: Xiaomin Wang, ; Yong Zhu,
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21
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Gong T, Jia B, Chen C, Zhang Z, Wang C. Clinical analysis of 78 pulmonary sarcomatoid carcinomas with surgical treatment. J Int Med Res 2022; 50:3000605221128092. [PMID: 36224744 PMCID: PMC9561649 DOI: 10.1177/03000605221128092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVE To evaluate clinical factors influencing the postoperative pulmonary sarcomatoid carcinoma (PSCs) prognosis. METHODS We retrospectively evaluated patients with PSCs treated from October 2012 to October 2017. Kaplan-Meier survival curves were calculated using univariable analysis (log-rank test). Univariable/multivariable Cox regression analysis was also performed. RESULTS Mixed PSCs were most common (64.10%). Pure PSCs occurred more often with large tumors compared with mixed PSCs. Patients with vs without pleural retraction, respectively, had significantly worse overall survival (OS; 16 vs 23 months) and disease-free survival (DFS; 11 vs 20 months), and patients with airway dissemination had significantly shorter OS (14 vs 21 months) and DFS (11 vs 20 months). Patients with PSC with an adenocarcinoma component had favorable OS. Airway dissemination, pleural retraction, metastatic mediastinal lymph node (LN) number, and pathological tumor-node-metastasis (pTNM) stage were risk factors for short OS. Neither adjuvant chemotherapy nor adjuvant radiotherapy provided a survival advantage. Airway dissemination was an independent prognostic factor (odds ratio, 1.87; 95% confidence interval, 1.04-3.36). CONCLUSION Pure PSCs were more likely with large tumors compared with mixed PSCs. Airway dissemination, pleural retraction, and metastatic mediastinal LN number were associated with OS. Airway dissemination was an independent prognostic factor.
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Affiliation(s)
- Ting Gong
- Department of Medical Oncology, Tianjin Medical University
General Hospital, Tianjin, China
| | - Bin Jia
- Department of Lung Cancer, Tianjin Lung Cancer Center, Tianjin
Medical University Cancer Institute and Hospital, National Clinical Research
Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin’s
Clinical Research Center for Cancer, Tianjin, China
| | - Chen Chen
- Department of Lung Cancer, Tianjin Lung Cancer Center, Tianjin
Medical University Cancer Institute and Hospital, National Clinical Research
Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin’s
Clinical Research Center for Cancer, Tianjin, China
| | - Zhenfa Zhang
- Department of Lung Cancer, Tianjin Lung Cancer Center, Tianjin
Medical University Cancer Institute and Hospital, National Clinical Research
Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin’s
Clinical Research Center for Cancer, Tianjin, China
| | - Changli Wang
- Department of Lung Cancer, Tianjin Lung Cancer Center, Tianjin
Medical University Cancer Institute and Hospital, National Clinical Research
Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin’s
Clinical Research Center for Cancer, Tianjin, China,Changli Wang, Department of Lung Cancer,
Tianjin Lung Cancer Center, Tianjin Medical University Cancer Institute and
Hospital, 20 HuanHu-Xi Road, Ti-Yuan-Bei, He Xi District, Tianjin 300060, China.
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22
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Okano Y, Morishita A, Naruse K, Takeuchi E. Positron Emission Tomography/Computed Tomography Findings of Granulocyte Colony-stimulating Factor-producing Lung Cancer. Intern Med 2022; 61:2241-2242. [PMID: 34980799 PMCID: PMC9381352 DOI: 10.2169/internalmedicine.8777-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Yoshio Okano
- Department of Respiratory Medicine, National Hospital Organization Kochi Hospital, Japan
| | - Atsushi Morishita
- Department of Thoracic Surgery, National Hospital Organization Kochi Hospital, Japan
| | - Keishi Naruse
- Department of Pathology, National Hospital Organization Kochi Hospital, Japan
| | - Eiji Takeuchi
- Department of Clinical Investigation, National Hospital Organization Kochi Hospital, Japan
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23
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Sun J, Jiang Z, Shan T, Yang R, Kong D, Rui J, Li X, Kong G, Chang B. Characteristics and Prognostic Analysis of 55 Patients With Pulmonary Sarcomatoid Carcinoma. Front Oncol 2022; 12:833486. [PMID: 35592676 PMCID: PMC9113756 DOI: 10.3389/fonc.2022.833486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Accepted: 03/24/2022] [Indexed: 11/19/2022] Open
Abstract
Pulmonary sarcomatoid carcinoma (PSC) is a rare and aggressive subtype of non-small-cell lung cancer (NSCLC). Here, we present information on the clinicopathologic characteristics and clinical outcomes of this type of cancer. Clinicopathologic data from 55 patients treated at a single cancer center from January 2011 to December 2018 were retrospectively analyzed. The patients were mostly male (76.4%), with a median age of 66 years and a history of smoking (54.5%). Most had symptoms, and about 60% presented with locally advanced or metastatic disease at diagnosis. Of the 55 cases, 21 were diagnosed by surgical resection. Pleomorphic cancer was the most common subtype (58.1%). With a median follow-up period of 13.2 months, the average survival time of the patients was 16.1 months, and the median survival time was 12 months. The overall survival rates for 1, 2, and 3 years were 52.7%, 18.2%, and 9.1%, respectively. Univariate analysis showed that prognosis of the patients was influenced by tumor size, T stage, metastatic status, and surgery (p < 0.05). Multivariate analysis showed that T stage (p = 0.034) was an independent prognostic factor. There are few reports on the natural history of PSC, and its clinicopathological characteristics remain unclear. Herein, a retrospective review 55 individuals with PSC found that T stage was an independent predictor of survival. Surgical resection was associated with better prognosis.
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Affiliation(s)
- Jiachun Sun
- Henan Key Laboratory of Cancer Epigenetics, Cancer Hospital, The First Affiliated Hospital, College of Clinical Medicine, Medical College of Henan University of Science and Technology, Luoyang, China
| | - Zhiyi Jiang
- Medical College, Henan University of Science and Technology, Luoyang, China
| | - Tanyou Shan
- Henan Key Laboratory of Cancer Epigenetics, Cancer Hospital, The First Affiliated Hospital, College of Clinical Medicine, Medical College of Henan University of Science and Technology, Luoyang, China
| | - Ruina Yang
- Henan Key Laboratory of Cancer Epigenetics, Cancer Hospital, The First Affiliated Hospital, College of Clinical Medicine, Medical College of Henan University of Science and Technology, Luoyang, China
| | - Dejiu Kong
- Henan Key Laboratory of Cancer Epigenetics, Cancer Hospital, The First Affiliated Hospital, College of Clinical Medicine, Medical College of Henan University of Science and Technology, Luoyang, China
| | - Junshuai Rui
- Henan Key Laboratory of Cancer Epigenetics, Cancer Hospital, The First Affiliated Hospital, College of Clinical Medicine, Medical College of Henan University of Science and Technology, Luoyang, China
| | - Xinyang Li
- Medical College, Henan University of Science and Technology, Luoyang, China
| | - Guoqiang Kong
- Henan Key Laboratory of Cancer Epigenetics, Cancer Hospital, The First Affiliated Hospital, College of Clinical Medicine, Medical College of Henan University of Science and Technology, Luoyang, China
| | - Baoping Chang
- Henan Key Laboratory of Cancer Epigenetics, Cancer Hospital, The First Affiliated Hospital, College of Clinical Medicine, Medical College of Henan University of Science and Technology, Luoyang, China
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24
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Liang Z, Zhang E, Duan L, Weygant N, An G, Hu B, Yao J. Establishment of a Competing Risk Nomogram in Patients with Pulmonary Sarcomatoid Carcinoma. Technol Cancer Res Treat 2022; 21:15330338211068960. [PMID: 35179409 PMCID: PMC8859694 DOI: 10.1177/15330338211068960] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Background and aim: Pulmonary sarcomatoid carcinoma (PSC) is a rare subtype of nonsmall cell lung cancer with a poor prognosis. This study aimed to analyze the clinicopathological characteristics and survival outcomes among patients with PSC, lung squamous cell cancer (SCC), and lung adenocarcinoma (LAC), and to construct a competing risk nomogram for patients with PSC. Method: Data of 3 groups of patients diagnosed with PSC, SCC, or LAC from the surveillance, epidemiology, and end results (SEER) database between 1988 and 2015 were retrospectively reviewed. A 1:1 propensity score matching (PSM) analysis was used to balance the baseline data of patients. Independent risk factors associated with survival outcomes were screened by the least absolute shrinkage and selection operator and further determined by univariate and multivariate Cox proportional risk regression analyses. The overall survival (OS) of patients was evaluated by Kaplan–Meier analysis and compared with a log-rank test. The cumulative incidence function was used to estimate the 5-year probabilities of the cancer-specific mortality of PSC. A nomogram was constructed to illustrate the competing risk model to predict the 3- and 5-year OS, and corresponding concordance indexes (C-indexes) and calibration curves were used to assess and validate the competing risk nomogram. Results: A total of 2285 patients with PSC were included in this study. Compared with SCC and LAC patients, the Kaplan–Meier analysis showed that patients with PSC had a worse prognosis, with a median survival of 5 months (95% confidence interval [CI]: 5-6 months) and a 5-year OS rate of 15.3% (95% CI: 13.9%-16.9%). Similar outcomes were demonstrated after 1:1 PSM. Moreover, the competing risk model showed that age, T stage, M stage, tumor size, lymph node ratio (LNR), surgery, and chemotherapy were associated with PSC-specific mortality. The 5-year C-index of the nomogram was 0.718. Calibration curves illustrated that the nomogram was well-validated and had great accuracy. Conclusions: Patients with PSC had a worse survival outcome compared with SCC or LAC patients. Age, T stage, M stage, tumor size, LNR, surgery, and chemotherapy were associated with PSC-specific mortality. The competing risk nomogram displayed excellent discrimination in predicting PSC-specific mortality.
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Affiliation(s)
- Ziwei Liang
- Beijing Chao-Yang Hospital, 74639Capital Medical University, Beijing, China
| | - Enyu Zhang
- 71043Beijing Fu Xing Hospital, Capital Medical University, Beijing, China
| | - Ling Duan
- Beijing Chao-Yang Hospital, 74639Capital Medical University, Beijing, China
| | - Nathaniel Weygant
- 47858Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, China.,Fujian Key Laboratory of Integrative Medicine in Geriatrics, Fuzhou, Fujian, China
| | - Guangyu An
- Beijing Chao-Yang Hospital, 74639Capital Medical University, Beijing, China
| | - Bin Hu
- Department of Thoracic Surgery, Beijing Chao-Yang Hospital, 74639Capital Medical University, Beijing, China
| | - Jiannan Yao
- Beijing Chao-Yang Hospital, 74639Capital Medical University, Beijing, China
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25
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Gu L, Wei X, Zhang Z, Heng W. Treatment Response to Immunotherapy After Crizotinib Resistance in a Patient With Pulmonary Sarcomatoid Carcinoma Harboring MET Exon 14 Skipping Mutation: A Case Report. Clin Med Insights Oncol 2022; 16:11795549211067185. [PMID: 35110965 PMCID: PMC8801627 DOI: 10.1177/11795549211067185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 11/29/2021] [Indexed: 12/02/2022] Open
Abstract
Pulmonary sarcomatoid carcinoma (PSC) is a rare subtype of non-small cell lung cancer (NSCLC) with poor prognosis. The skipping mutation in exon 14 of MET, an oncogenic driver of NSCLC, occurs more frequently in PSC than other subtypes. Treatment options for patients with PSC include targeted therapies and immunotherapies, while the best treatment regimen has not been established due to limited number of patients. In this report, we presented a case with metastatic PSC harboring MET 14 exon skipping mutation. The patient received crizotinib but soon acquired drug resistance. Then, the patient turned to immunotherapy in combination with chemotherapy and has achieved a progression-free survival for 15 months as of the data cutoff date. The comprehensive genomic sequencing after crizotinib resistance revealed additional genetic alterations such as CD274 (also known as programmed cell death ligand 1) amplification which might be associated with treatment response of the patient.
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Affiliation(s)
- Ling Gu
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Xiaoying Wei
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Zixiang Zhang
- Department of General Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Wei Heng
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Soochow University, Suzhou, China
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26
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Xu L, Tao NN, Liang B, Li DW, Li HC, Su LL. Use of PD-1 inhibitor tislelizumab in the treatment of advanced pulmonary sarcomatoid carcinoma: A case report. Thorac Cancer 2021; 13:502-505. [PMID: 34953097 PMCID: PMC8807335 DOI: 10.1111/1759-7714.14290] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Revised: 12/06/2021] [Accepted: 12/08/2021] [Indexed: 11/30/2022] Open
Abstract
Pulmonary sarcomatoid carcinoma (PSC), characterized by poor differentiation, aggressive progression, and early metastasis, is a rare type of non‐small cell lung carcinoma (NSCLC), which shows a low response rate to conventional antitumor therapies and has a poor prognosis. With the achievements in gene sequencing, targeted therapy, and immunotherapy, several new approaches have recently been explored in PSC treatment. A small case series of PSC patients were found to have programmed death‐ligand 1 (PD‐L1) overexpression, a prerequisite for PD‐1 inhibiting therapy, which made immunotherapy possible. However, anti‐PD‐1 treatment for PSCs was still at a preliminary stage. Here, we report the successful outcome of tislelizumab monotherapy in a patient with advanced PSC with pleural invasion, thus providing a novel promising approach for PSC patients with PD‐L1 overexpression.
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Affiliation(s)
- Li Xu
- Department of Respiratory and Critical Care Medicine, Shandong Provincial Hospital Affiliated to Shandong University, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Ning-Ning Tao
- Department of Respiratory and Critical Care Medicine, Shandong Provincial Hospital Affiliated to Shandong University, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Bin Liang
- Department of Respiratory and Critical Care Medicine, Shandong Provincial Hospital Affiliated to Shandong University, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Dao-Wei Li
- Department of Respiratory and Critical Care Medicine, Shandong Provincial Hospital Affiliated to Shandong University, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Huai-Chen Li
- Department of Respiratory and Critical Care Medicine, Shandong Provincial Hospital Affiliated to Shandong University, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China.,College of Traditional Chinese Medicine, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Li-Li Su
- Department of Respiratory and Critical Care Medicine, Shandong Provincial Hospital Affiliated to Shandong University, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
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27
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Abstract
Pulmonary sarcomatoid carcinoma (PSC) is a pathological subtype of non-small cell lung cancer. Although the incidence of PSC in lung cancer is very low, it is an aggressive cancer, leading to a poor prognosis. Currently, there is no standard treatment for advanced PSC. Targeted therapy can be used for patients with MET exon 14 mutations and patients with other driver gene mutations may also benefit from treatment. The emergence of immune checkpoint inhibitors also provides potential options for advanced PSC treatment, but more clinical data is needed. Additionally, more research may be warranted to explore the effects of chemotherapy, radiotherapy and antiangiogenic therapy. In this review, the authors summarize the research regarding the treatment of advanced PSC.
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Affiliation(s)
- Yue Zheng
- Department of Biotherapy, Cancer Center, West China Hospital, West China Medical School, Sichuan University, Chengdu 610041, China
| | - Yang Fu
- Department of Biotherapy, Cancer Center, West China Hospital, West China Medical School, Sichuan University, Chengdu 610041, China
| | - Qin Zhong
- Department of Oncology, The People's Hospital of Guizhou Province, Guiyang 550001, China
| | - Rong Deng
- Department of Oncology, The People's Hospital of Guizhou Province, Guiyang 550001, China
| | - Yu Zhang
- Department of Oncology, The People's Hospital of Guizhou Province, Guiyang 550001, China
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28
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Otsubo K, Sakai H, Kimura H, Miyazawa T, Marushima H, Kojima K, Furuya N, Mineshita M, Chosokabe M, Koike J, Saji H. Thoracic mesenchymal malignant tumors and programed cell death ligand-1 status: Clinicopathologic and prognostic analysis of eight pulmonary sarcomatoid carcinomas and eight malignant mesotheliomas. Thorac Cancer 2021; 12:3169-3176. [PMID: 34655161 PMCID: PMC8636199 DOI: 10.1111/1759-7714.14177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 09/14/2021] [Accepted: 09/16/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND The current study aimed to evaluate the significance of clinicopathological factors, particularly the immunohistochemistry of programed cell death ligand-1 (PD-L1), in eight cases each of pulmonary sarcomatoid carcinoma (PSC) and malignant pleural mesothelioma (MPM) at our hospital. METHODS From January 2004 to December 2020, a total of 16 consecutive patients (eight with PSC and eight with MPM diagnosed via surgical resection or biopsy) were included in this study. After retrospectively reviewing the patient characteristics, the associations between PD-L1 status and age, sex, stage, histological type, and prognosis were investigated. RESULTS PD-L1-positive staining was observed in four (50%) PSC cases and one (12.5%) MPM case. Among the four PD-L1-positive PSC cases, two showed high PD-L1 expression in the vimentin-positive sarcomatoid compartment. Moreover, among those with PSC, two survived for about 10 years, whereas the others died within 5 years. No clear correlation was found between PD-L1 expression and prognosis. Among the patients with MPM, four survived for more than 2 years, with the longest being 9 years. Among MPM cases who received nivolumab, one patient with positive PD-L1 staining in the sarcomatoid survived, whereas the other with negative PD-L1 staining did not. CONCLUSION The present study showed that sarcomatoid carcinoma had a higher PD-L1 expression compared to non-small-cell lung cancer and that both PSC and MPM tended to exhibit PD-L1 positivity in the sarcomatoid compartment. Moreover, while immune checkpoint inhibitors may somewhat prolong the prognosis of both tumors, further studies with a larger cohort are necessary to confirm our results.
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Affiliation(s)
- Kanji Otsubo
- Departments of Chest SurgerySt. Marianna University School of MedicineKawasakiJapan
| | - Hiroki Sakai
- Departments of Chest SurgerySt. Marianna University School of MedicineKawasakiJapan
| | - Hiroyuki Kimura
- Departments of Chest SurgerySt. Marianna University School of MedicineKawasakiJapan
| | - Tomoyuki Miyazawa
- Departments of Chest SurgerySt. Marianna University School of MedicineKawasakiJapan
| | - Hideki Marushima
- Departments of Chest SurgerySt. Marianna University School of MedicineKawasakiJapan
| | - Koji Kojima
- Departments of Chest SurgerySt. Marianna University School of MedicineKawasakiJapan
| | - Naoki Furuya
- Division of Respiratory Medicine, Department of Internal MedicineSt. Marianna University School of MedicineKawasakiJapan
| | - Masamichi Mineshita
- Division of Respiratory Medicine, Department of Internal MedicineSt. Marianna University School of MedicineKawasakiJapan
| | - Motohiro Chosokabe
- Department of PathologySt. Marianna University School of MedicineKawasakiJapan
| | - Junki Koike
- Department of PathologySt. Marianna University School of MedicineKawasakiJapan
| | - Hisashi Saji
- Departments of Chest SurgerySt. Marianna University School of MedicineKawasakiJapan
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29
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Wang L, Zhang J, Chen X, Liang M, Li S, Zhou W, Cao J. Pulmonary sarcomatoid carcinoma mimicking pleural mesothelioma: A case report. Medicine (Baltimore) 2021; 100:e27813. [PMID: 34766593 PMCID: PMC8589231 DOI: 10.1097/md.0000000000027813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 10/29/2021] [Indexed: 01/05/2023] Open
Abstract
INTRODUCTION Pulmonary sarcomatoid carcinoma (PSC) is an extremely rare biphasic tumor characterized by a mixture of malignant epithelial and mesenchymal cells. Owing to the rarity, as well as the lack of typical manifestations and imaging signs, the rate of misdiagnosis is high. Herein, we present a case of PSC misdiagnosed as pleural mesothelioma in a 59-year-old man. PATIENT CONCERNS A 59-year-old man presented with recurrent coughing, fever, and chest pain. DIAGNOSIS Chest computed tomography showed 2 large and dense masses involving the inferior lobes of right lung, along with slight irregular pleural thickening and a small amount of effusion. INTERVENTIONS Chest computed tomography-guided tumor biopsy was performed. PSC was confirmed based on histopathology and immunohistochemistry. The patient refused treatment due to economic reasons. OUTCOMES The patient developed adrenal, multiple lung and brain metastasis. The overall survival time was 11 months. CONCLUSIONS PSC, despite its rarity, should be considered in the differential diagnosis of lung cancer. Besides, biopsy, histopathology, and specific immunohistochemical staining of larger tissue specimens can be contributing to the accurate diagnosis of PSC.
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30
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Chen M, Yang Q, Xu Z, Luo B, Li F, Yu Y, Sun J. Survival Analysis and Prediction Model for Pulmonary Sarcomatoid Carcinoma Based on SEER Database. Front Oncol 2021; 11:630885. [PMID: 34136380 PMCID: PMC8201495 DOI: 10.3389/fonc.2021.630885] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 05/11/2021] [Indexed: 02/05/2023] Open
Abstract
Objective This study aimed to investigate the incidence of the pulmonary sarcomatoid carcinoma (PSC), to compare the clinical characteristics and overall survival (OS) of patients with PSC and those with other non-small-cell lung cancer (oNSCLC), so as to analyze the factors affecting the OS of patients with PSC and construct a nomogram prediction model. Methods Data of patients with PSC and those with oNSCLC diagnosed between 2004 and 2015 from the Surveillance, Epidemiology, and End Results database were collected. The age-adjusted incidence of PSC was calculated. The characteristics of patients with PSC and those with oNSCLC were compared, then the patients were matched 1:2 for further survival analysis. Patients with PSC were randomly divided into training set and testing set with a ratio of 7:3. The Cox proportional hazards model was used to identify the covariates associated with the OS. Significant covariates were used to construct the nomogram, and the C-index was calculated to measure the discrimination ability. The accuracy of the nomogram was compared with the tumor–node–metastasis (TNM) clinical stage, and the corresponding area under the curve was achieved. Results A total of 1049 patients with PSC were enrolled, the incidence of PSC was slowly decreased from 0.120/100,000 in 2004 to 0.092/100,000 in 2015. Before PSM, 793 PSC patients and 191356 oNSCLC patients were identified, the proportion of male, younger patients (<65 years), grade IV, TNM clinical stage IV was higher in the PSC. The patients with PSC had significantly poorer OS compared with those with oNSCLC. After PSM, PSC still had an extremely inferior prognosis. Age, sex, TNM clinical stage, chemotherapy, radiotherapy, and surgery were independent factors for OS. Next, a nomogram was established based on these factors, and the C-indexs were 0.775 and 0.790 for the training and testing set, respectively. Moreover, the nomogram model indicated a more comprehensive and accurate prediction than the TNM clinical stage. Conclusions The incidence of PSC was slowly decreased. PSC had a significantly poor prognosis compared with oNSCLC. The nomogram constructed in this study accurately predicted the prognosis of PSC, performed better than the TNM clinical stage.
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Affiliation(s)
- Mingjing Chen
- Cancer Institute, Xinqiao Hospital, Army Medical University, Chongqing, China.,Chongqing Key Laboratory of Infectious Diseases and Parasitic Diseases, Department of Infectious Diseases, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Qiao Yang
- Cancer Institute, Xinqiao Hospital, Army Medical University, Chongqing, China.,Department of Ultrasound, The 941st Hospital of the PLA Joint Logistic Support Force, Xining, China
| | - Zihan Xu
- Cancer Institute, Xinqiao Hospital, Army Medical University, Chongqing, China.,Lung Cancer Center, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital of Sichuan University, Chengdu, China
| | - Bangyu Luo
- Cancer Institute, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Feng Li
- Cancer Institute, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Yongxin Yu
- Cancer Institute, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Jianguo Sun
- Cancer Institute, Xinqiao Hospital, Army Medical University, Chongqing, China
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Taniguchi H, Takemoto S, Ozasa M, Honda N, Suyama T, Umeyama Y, Dotsu Y, Nakao T, Tomohito K, Gyotoku H, Yamaguchi H, Miyazaki T, Sakamoto N, Obase Y, Fukuda M, Fukuoka J, Mukae H. Remarkable response to pembrolizumab with platinum-doublet in PD-L1-low pulmonary sarcomatoid carcinoma: A case report. Thorac Cancer 2021; 12:1126-1130. [PMID: 33605089 PMCID: PMC8017259 DOI: 10.1111/1759-7714.13890] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 01/28/2021] [Accepted: 01/29/2021] [Indexed: 01/06/2023] Open
Abstract
Pulmonary sarcomatoid carcinoma (SC) is an aggressive subtype of lung cancer that exhibits resistance to cytotoxic chemotherapy. Although programmed cell death 1 (PD‐1) inhibitors have been reported to show antitumor effects in patients with high programmed death‐ligand 1 (PD‐L1) expressing SC, the efficacy of combined therapy with PD‐1 inhibitor plus cytotoxic chemotherapy has not previously been clarified. We herein report a case of SC with low expression of PD‐L1 and few pre‐existing tumor‐infiltrating lymphocytes which showed a remarkable response to pembrolizumab plus cytotoxic chemotherapy as first‐line treatment. Our findings suggest that combined treatment might enhance the immunogenic response, even in immunologically ignored SCs.
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Affiliation(s)
- Hirokazu Taniguchi
- Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.,Molecular Pharmacology Program and Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Shinnosuke Takemoto
- Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Mutsumi Ozasa
- Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.,Department of Pathology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Noritaka Honda
- Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Takayuki Suyama
- Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Yasuhiro Umeyama
- Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Yosuke Dotsu
- Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Takumi Nakao
- Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Kojima Tomohito
- Department of Gastroenterology and Hepatology, Nagasaki University Hospital, Nagasaki, Japan
| | - Hiroshi Gyotoku
- Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Hiroyuki Yamaguchi
- Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Taiga Miyazaki
- Department of Infectious Diseases, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Noriho Sakamoto
- Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Yasushi Obase
- Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Minoru Fukuda
- Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.,Clinical Oncology Center, Nagasaki University Hospital, Nagasaki, Japan
| | - Junya Fukuoka
- Department of Pathology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Hiroshi Mukae
- Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
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Abdallah HM, Martinez-Meehan D, Lutfi W, Dhupar R, Grenda T, Schuchert MJ, Christie NA, Luketich JD, Okusanya OT. Adjuvant chemotherapy for pulmonary sarcomatoid carcinoma: A retrospective analysis of the National Cancer Database. J Thorac Cardiovasc Surg 2021; 163:1669-1681.e3. [PMID: 33678508 DOI: 10.1016/j.jtcvs.2021.01.081] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 01/15/2021] [Accepted: 01/21/2021] [Indexed: 02/06/2023]
Abstract
OBJECTIVES Pulmonary sarcomatoid carcinoma (PSC) is a rarely occurring variant of non-small cell lung cancer with sarcoma-like features. Compared with traditional non-small cell lung cancer, PSC patients typically present later and have poorer prognoses, irrespective of stage. The standard of care is resection, but guidelines for the use of adjuvant chemotherapy have not been established. To advance the development of evidence-based management algorithms for PSC after resection, a statistical analysis on a nationwide representative sample of patients was performed. METHODS A retrospective cohort study was performed by querying the National Cancer Database for patients with a diagnosis of PSC between 2004 and 2015. Patients who received complete anatomical resection with or without adjuvant chemotherapy were included. Multivariable regression was used to detect factors associated with the receipt of adjuvant chemotherapy. Multivariable Cox regression of overall survival and Kaplan-Meier survival analysis on propensity-matched groups was conducted to study the association between adjuvant chemotherapy and prognosis. RESULTS We included 1497 patients with PSC in the final analysis. Factors associated with receiving adjuvant chemotherapy were age, histology, and receipt of adjuvant radiation. The results of multivariable Cox analysis and Kaplan-Meier analysis on propensity matched groups yielded similar trends: adjuvant chemotherapy was associated with improved 5-year overall survival for stage II and III disease, but not for stage I disease. CONCLUSIONS Multiple factors are associated with receipt of adjuvant chemotherapy for PSC, and this treatment appears to be associated with improved survival in stage II and stage III, but not stage I patients.
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Affiliation(s)
| | | | - Waseem Lutfi
- Department of Surgery, Penn Medicine, Philadelphia, Pa
| | - Rajeev Dhupar
- Department of Cardiothoracic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pa; Surgical Services Division, VA Pittsburgh Healthcare System, Pittsburgh, Pa
| | - Tyler Grenda
- Department of Surgery, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pa
| | - Matthew J Schuchert
- Department of Cardiothoracic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pa
| | - Neil A Christie
- Department of Cardiothoracic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pa
| | - James D Luketich
- Department of Cardiothoracic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pa
| | - Olugbenga T Okusanya
- Department of Surgery, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pa.
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Kim M, Keam B, Ock C, Kim SH, Kim YJ, Lim SM, Kim J, Kim TM, Hong S, Ahn MS, Shin SH, Kang EJ, Kim D, Im S, Kim J, Lee JS, Kim J, Heo DS. Phase II study of durvalumab and tremelimumab in pulmonary sarcomatoid carcinoma: KCSG-LU16-07. Thorac Cancer 2020; 11:3482-3489. [PMID: 33026712 PMCID: PMC7705626 DOI: 10.1111/1759-7714.13684] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 09/16/2020] [Accepted: 09/16/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Pulmonary sarcomatoid carcinoma (PSC) is rare with a poor outcome and is resistant to conventional cytotoxic chemotherapy. The efficacy and safety of durvalumab and tremelimumab for treating recurrent or metastatic PSCs were assessed by a nonrandomized, open-label, phase II study. METHODS A total of 18 patients with recurrent or metastatic PSC received 1500 mg of durvalumab and 75 mg of tremelimumab every four weeks, followed by 750 mg of durvalumab every two weeks until the disease progressed, or an unacceptable toxicity level was reached. The primary endpoint was the objective response rate (ORR). The secondary endpoints were progression-free survival (PFS), overall survival (OS), and toxicity. Genomic profiling of PSC by next-generation sequencing (NGS) and determination of peripheral blood lymphocyte subsets using flow cytometry were performed for exploratory analysis. RESULTS A total of 15 out of 18 patients were evaluated for the analysis of the primary endpoint. At the data cutoff point, the ORR of 26.7% (95% confidence interval [CI]: 7.8-55.1) was achieved with the median follow-up duration of 12.0 months (range, 8.4-16.1). Median PFS and OS were 5.9 months (95% CI: 1.1-11.9) and 15.4 months (95% CI: 11.1-not reached), respectively. Treatment-related adverse events (AEs) of any grade were reported in 16 patients; the most common AEs were pruritus (n = 5), pneumonitis (n = 4), and rash (n = 4). Treatment was discontinued in two patients due to AEs of grade ≥ 3. CONCLUSIONS Durvalumab and tremelimumab demonstrated clinical benefit with a prolonged survival and manageable toxicity profile in patients with recurrent or metastatic PSC.
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Affiliation(s)
- Miso Kim
- Department of Internal Medicine, Seoul National University HospitalSeoul National University College of MedicineSeoulRepublic of Korea
- Cancer Research InstituteSeoul National University College of MedicineSeoulRepublic of Korea
| | - Bhumsuk Keam
- Department of Internal Medicine, Seoul National University HospitalSeoul National University College of MedicineSeoulRepublic of Korea
- Cancer Research InstituteSeoul National University College of MedicineSeoulRepublic of Korea
| | - Chan‐Young Ock
- Department of Internal Medicine, Seoul National University HospitalSeoul National University College of MedicineSeoulRepublic of Korea
- Cancer Research InstituteSeoul National University College of MedicineSeoulRepublic of Korea
| | - Se Hyun Kim
- Department of Internal Medicine, Seoul National University Bundang HospitalSeoul National University College of MedicineSeongnamRepublic of Korea
| | - Yu Jung Kim
- Department of Internal Medicine, Seoul National University Bundang HospitalSeoul National University College of MedicineSeongnamRepublic of Korea
| | - Sun Min Lim
- Department of Internal Medicine, CHA Bundang Medical CenterSeongnamRepublic of Korea
| | - Jin‐Soo Kim
- Department of Internal MedicineSeoul National University Boramae Medical CenterSeoulRepublic of Korea
| | - Tae Min Kim
- Department of Internal Medicine, Seoul National University HospitalSeoul National University College of MedicineSeoulRepublic of Korea
- Cancer Research InstituteSeoul National University College of MedicineSeoulRepublic of Korea
| | - Sook‐Hee Hong
- Department of Internal Medicine, Seoul St. Mary's Hospital, College of MedicineThe Catholic University of KoreaSeoulRepublic of Korea
| | - Mi Sun Ahn
- Department of Hematology‐OncologyAjou University School of MedicineSuwonRepublic of Korea
| | - Seong Hoon Shin
- Department of Internal MedicineKosin University Gospel HospitalBusanRepublic of Korea
| | - Eun Joo Kang
- Department of Internal Medicine, Korea University Medical CenterKorea University College of MedicineSeoulRepublic of Korea
| | - Dong‐Wan Kim
- Department of Internal Medicine, Seoul National University HospitalSeoul National University College of MedicineSeoulRepublic of Korea
- Cancer Research InstituteSeoul National University College of MedicineSeoulRepublic of Korea
| | - Sun‐Wha Im
- Genomic Medicine Institute, Medical Research CenterSeoul National UniversitySeoulRepublic of Korea
| | - Jong‐Il Kim
- Cancer Research InstituteSeoul National University College of MedicineSeoulRepublic of Korea
- Genomic Medicine Institute, Medical Research CenterSeoul National UniversitySeoulRepublic of Korea
- Department of Biomedical ScienceSeoul National University Graduate SchoolSeoulRepublic of Korea
| | - Jong Seok Lee
- Department of Internal Medicine, Seoul National University Bundang HospitalSeoul National University College of MedicineSeongnamRepublic of Korea
| | - Joo‐Hang Kim
- Department of Internal Medicine, CHA Bundang Medical CenterSeongnamRepublic of Korea
| | - Dae Seog Heo
- Department of Internal Medicine, Seoul National University HospitalSeoul National University College of MedicineSeoulRepublic of Korea
- Cancer Research InstituteSeoul National University College of MedicineSeoulRepublic of Korea
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Robinson LA, Babacan NA, Tanvetyanon T, Henderson-Jackson E, Bui MM, Druta M. Results of treating primary pulmonary sarcomas and pulmonary carcinosarcomas. J Thorac Cardiovasc Surg 2021; 162:274-84. [PMID: 32711968 DOI: 10.1016/j.jtcvs.2020.03.179] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 03/15/2020] [Accepted: 03/24/2020] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Primary pulmonary sarcomas (PPS) and pulmonary carcinosarcomas (PCS) are rare aggressive lung malignancies. We reviewed our 21-year experience with the surgical and nonsurgical treatment of both tumors, comparing their clinical, histopathologic, and treatment results. METHODS All patients with PPS or PCS who underwent surgical and nonsurgical treatment between 1998 and 2019 at our cancer center were retrospectively reviewed. Multivariable Cox proportional hazards model was constructed. RESULTS In total, 100 patients were analyzed: 45 with PPS and 55 with PCS. Among patients with PPS, 31 of 45 (69%) underwent surgery with 1 (3%) operative mortality. For patients with PCS, 29 of 55 (53%) underwent surgery with no operative mortality. Patients with PPS were younger than PCS (P < .01). Fewer patients were smokers among PPS (58%) versus PCS (93%) (P < .01). For resected PPS, mean tumor size was 8.2 ± 4.1 cm (range 2.2-18.0) compared with 10.1 ± 5.0 cm (range 3.9-17.0) for unresected PPS. Tumor size for resected PCS was 6.2 ± 2.6 cm (range 2.0-10.5) versus 6.8 ± 3.5 cm (range 1.2-13.5) for unresected PCS. Of resected patients, 5 of 31 (16%) with PPS and 9 of 29 (31%) with PCS were node positive. Overall survival estimates were as follows: for PPS, median survival and 5-year overall survival for resected versus unresected cases were 39.6 months/28.7% versus 4.9 months/7.8%. For PCS, survival estimates were 23.6 months/31.0% versus 14.9 months/28.2%, respectively. In multivariable analyses (N = 100), age, smoking history, histology, and surgery were risk factors of survival. CONCLUSIONS At initial evaluation, PPS and PCS presented with large-sized tumors and usually were not stage I. Surgery had a positive impact on survival among patients with PPS. Whenever feasible, surgical resection, even in locally advanced disease, may yield long-term survival in these aggressive lung tumors, although the level of evidence is low.
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Kong FW, Wang WM, Liu L, Wu WB, Wang X, Zhang M. First-line albumin-bound paclitaxel/carboplatin plus apatinib in advanced pulmonary sarcomatoid carcinoma: A case series and review of the literature. Medicine (Baltimore) 2020; 99:e20667. [PMID: 32502055 PMCID: PMC7306366 DOI: 10.1097/md.0000000000020667] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
RATIONALE Pulmonary sarcomatoid carcinoma (PSC) is an uncommon type of non-small cell lung cancer, exhibiting aggressive behavior and resistance to the conventional chemoradiotherapy. To date, the optimal treatment for PSC has not been elucidated. PATIENT CONCERNS Three male patients including a 69-year-old smoker (Case 1), a 45-year-old non-smoker (Case 2), and a 69-year-old smoker (Case 3) were admitted because of cough, back pain, and loss of body weight respectively. DIAGNOSES Radiographical examinations in these patients showed bulky intrathoracic lesions, which were pathologically diagnosed as PSC staging III-IV by computed tomography-guided percutaneous biopsy and endoscopy. INTERVENTIONS Immunotherapy was not covered by their health insurance and they refused immune checkpoint inhibitors for financial reasons. In addition, a radical resection was not appropriate due to the advanced staging of these lesions. Therefore, first-line albumin-bound paclitaxel (nab-paclitaxel, 260 mg/m of the body surface area) and carboplatin (area under curve 5) combined with oral apatinib (425 mg, daily) were administered empirically. OUTCOMES Two patients achieved a partial response and the other case showed stable disease lasting for more than 6 months. However, 1 of them indicated progression on the 7-month follow up. LESSONS Nab-paclitaxel/carboplatin plus apatinib showed limited short-term efficacy in advanced, unresectable PSC. The rapid resistance of PSC to the current therapeutic regimen necessitates further researches, as more effective agents are urgently needed.
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Affiliation(s)
- Feng-Wei Kong
- Department of General Surgery, Xuzhou Infectious Disease Hospital
| | - Wei-Min Wang
- Department of General Surgery, Xuzhou Infectious Disease Hospital
| | - Lei Liu
- Department of Gastroenterology, Yichang Central People's Hospital, Institute of Digestive Disease, China Three Gorges University, Yichang
| | - Wen-Bin Wu
- Department of Surgery, Xuzhou Central Hospital, Xuzhou, China
| | - Xiang Wang
- Department of Surgery, Xuzhou Central Hospital, Xuzhou, China
| | - Miao Zhang
- Department of Surgery, Xuzhou Central Hospital, Xuzhou, China
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Xie X, Tu N, Wang Q, Cheng Z, Han X, Bu L. 18 F-FDG PET/CT imaging of small intestinal metastasis from pulmonary sarcomatoid carcinoma: Brief report and review of the literature. Thorac Cancer 2020; 11:2325-2330. [PMID: 32410331 PMCID: PMC7396377 DOI: 10.1111/1759-7714.13468] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 04/15/2020] [Accepted: 04/18/2020] [Indexed: 12/13/2022] Open
Abstract
We herein report two cases of small intestinal metastasis from pulmonary sarcomatoid carcinoma (PSC) detected by 18F‐fluorodeoxyglucose positron emission tomography/computed tomography (18F‐FDG PET/CT). We reviewed the literature on 18F‐FDG PET/CT features in gastrointestinal metastasis of PSC patients since 1992, and further analyzed the imaging features. According to the literature review, 23 eligible cases were identified from eight studies, and no cases underwent 18F‐FDG PET/CT imaging. In this study, clinical and PET/CT imaging data of two patients are reported. In our cases, clinical and the CT images of lung masses were not typical, but the uptake of 18F‐FDG was remarkably high, with SUVmax exceeding 30. Small intestinal metastases may not be related to obstruction, or even the local intestinal cavity may be dilated. Therefore, in PSC patients with mild or without abdominal symptoms, 18F‐FDG PET/CT imaging could identify intestinal metastasis at a relatively early stage and may be used to determine the preferred biopsy site, or early intervention by surgery. Key points 18F‐FDG PET/CT imaging of small intestinal metastasis of PSC has not been previously reported in the literature and here we report the 18F‐FDG PET/CT features of two cases. The uptake of 18F‐FDG was remarkably high in both the primary tumor and metastatic intestinal lesion. 18F‐FDG PET/CT imaging may therefore be used to determine the preferred biopsy site or early intervention by surgery.
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Affiliation(s)
- Xinli Xie
- Department of Nuclear Medicine, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Ning Tu
- PET-CT/MRI Center & Molecular Imaging Center, Wuhan University Renmin Hospital, Wuhan, China
| | - Qi Wang
- The 1st Department of Gastrointestinal Surgery, Wuhan University Renmin Hospital, Wuhan, China
| | - Zhen Cheng
- Molecular Imaging Program at Stanford (MIPS), Department of Radiology and Bio-X Program, Stanford University, Stanford, California, USA
| | - Xingmin Han
- Department of Nuclear Medicine, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Lihong Bu
- PET-CT/MRI Center & Molecular Imaging Center, Wuhan University Renmin Hospital, Wuhan, China
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Liang X, Cheng Y, Yuan Z, Yan Z, Li Q, Huang Y, Feng G. Clinical, pathological and treatment factors associated with the survival of patients with pulmonary sarcomatoid carcinoma. Oncol Lett 2020; 19:4031-4039. [PMID: 32382345 PMCID: PMC7202303 DOI: 10.3892/ol.2020.11472] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 02/19/2020] [Indexed: 12/29/2022] Open
Abstract
Pulmonary sarcomatoid carcinoma (PSC) is a group of five rare non-small cell lung cancer subtypes. In the present study, the clinical characteristics and outcomes of patients with PSC registered in the Surveillance, Epidemiology and End Results (SEER) database were investigated. For this purpose, data for patients with PSC (n=1,723) who received their initial diagnosis between 1988 and 2016 were collected from the SEER database. Survival analysis was performed using the Kaplan-Meier curves and the log-rank test. Subsequently, multivariate analyses with the Cox proportional hazards model were used to identify significant independent predictors. A nomogram model was established to predict survival performance using the concordance index (C-index). From the total cohort, patients with pulmonary blastoma demonstrated improved 1-year overall survival (OS) rate compared with other pathological types (P<0.001). The 2-year overall survival rates of the ‘only radiotherapy’ cohort and the ‘no specific treatment’ cohort were 9.1 and 5.4% (P<0.001), respectively. Radiotherapy significantly improved the OS rate in stage I–III patients with PSC (P<0.001) when stratified by stage. After matching the propensity scores, the ‘surgery combined with radiotherapy’ group comprised 156 patients and the ‘surgery-only’ group had 247 patients (1:1.6). However, no significant differences in prognosis were found between the 2 subgroups (P=0.052). The multivariate Cox analysis demonstrated that older age (≥76 years old), male, unmarried, pathological type, larger tumor size (≥56 mm), later tumor node metastasis stages and treatment modalities were independent prognostic factors. A nomogram model was established to predict the survival of patients with PSC. This model incorporated the seven aforementioned independent prognostic factors (C-index for survival, 0.75; 95% confidence interval, 0.74–0.76). Radiotherapy needs to considered for stage I–III patients with PSC who undergo radiation therapy without surgical resection.
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Affiliation(s)
- Xiaohong Liang
- Department of Pulmonary and Critical Care Medicine, Zhangjiagang Traditional Chinese Medicine Hospital Affiliated to Nanjing University of Chinese Medicine, Zhangjiagang, Jiangsu 215600, P.R. China
| | - Yinan Cheng
- Department of Pulmonary and Critical Care Medicine, Zhangjiagang Traditional Chinese Medicine Hospital Affiliated to Nanjing University of Chinese Medicine, Zhangjiagang, Jiangsu 215600, P.R. China
| | - Zijiang Yuan
- Department of Ear, Nose and Throat, Zhangjiagang Traditional Chinese Medicine Hospital Affiliated to Nanjing University of Chinese Medicine, Zhangjiagang, Jiangsu 215600, P.R. China
| | - Zhengping Yan
- Department of Pulmonary and Critical Care Medicine, Zhangjiagang Traditional Chinese Medicine Hospital Affiliated to Nanjing University of Chinese Medicine, Zhangjiagang, Jiangsu 215600, P.R. China
| | - Quqing Li
- Department of Pulmonary and Critical Care Medicine, Zhangjiagang Traditional Chinese Medicine Hospital Affiliated to Nanjing University of Chinese Medicine, Zhangjiagang, Jiangsu 215600, P.R. China
| | - Yuan Huang
- Department of Cardiovascular Medicine, Zhangjiagang Traditional Chinese Medicine Hospital Affiliated to Nanjing University of Chinese Medicine, Zhangjiagang, Jiangsu 215600, P.R. China
| | - Gaohua Feng
- Department of Pulmonary and Critical Care Medicine, Zhangjiagang Traditional Chinese Medicine Hospital Affiliated to Nanjing University of Chinese Medicine, Zhangjiagang, Jiangsu 215600, P.R. China
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Sahay A, Kumar R, Janu A, Prabhash K. ALK1 Gene Rearranged Pulmonary Sarcomatoid Carcinoma Masquerading as Tuberculosis in a Young Male. Turk Patoloji Derg 2020; 1:71-77. [PMID: 32149365 PMCID: PMC10508925 DOI: 10.5146/tjpath.2020.01481] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 02/15/2020] [Indexed: 11/18/2022] Open
Abstract
Pulmonary sarcomatoid carcinoma is rare, with limited treatment options and poor prognosis. In contrast to other non small cell lung carcinomas, not much is known about its molecular biology. In an endemic country like India, lung cancer is often masked by tuberculosis and presents in advanced stages. We report here an unusual case of pulmonary sarcomatoid carcinoma, in a young non-smoker male, who had co-existent tuberculosis masking and delaying the diagnosis of malignancy. On molecular study, the tumor showed ALK gene rearrangement, both by immunohistochemistry and fluorescence in-situ hybridization, which has been reported only twice previously. Presence of ALK gene rearrangements in sarcomatoid carcinoma has significant therapeutic implications and potential for altering the prognosis of this fatal disease. Hence we recommend performing ALK gene rearrangement analysis in all cases of sarcomatoid lung carcinomas. The report discusses the diagnostic approach and provides insight into the molecular pathogenesis of this exceedingly rare malignancy.
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Affiliation(s)
- Ayushi Sahay
- Department of Pathology, Tata Memorial Center, Homi Bhabha National Institute (HBNI), Parel, Mumbai, India
| | - Rajiv Kumar
- Department of Pathology, Tata Memorial Center, Homi Bhabha National Institute (HBNI), Parel, Mumbai, India
| | - Amit Janu
- Department of Radiology, Tata Memorial Center, Homi Bhabha National Institute (HBNI), Parel, Mumbai, India
| | - Kumar Prabhash
- Department of Medical Oncology, Tata Memorial Center, Homi Bhabha National Institute (HBNI), Parel, Mumbai, India
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D’Antonio F, De Sanctis R, Bolengo I, Destro A, Rahal D, De Vincenzo F, Santoro A. Pulmonary sarcomatoid carcinoma presenting both ALK rearrangement and PD-L1 high positivity: A case report on the therapeutic regimen. Medicine (Baltimore) 2019; 98:e16754. [PMID: 31393391 PMCID: PMC6708868 DOI: 10.1097/md.0000000000016754] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
RATIONALE Pulmonary sarcomatoid carcinoma (PSC) represents <1% of all lung cancers and is characterized by a very poor prognosis. The optimal therapeutic regimen remains unclear. We describe a rare case of PSC with both anaplastic lymphoma kinase (ALK)-arranged and high levels of programmed death ligand 1 (PD-L1) expression. PATIENT CONCERNS A 46-year-old woman, nonsmoker, came to our attention due to uncontrolled pain in the lower left limb. DIAGNOSIS PSC with both ALK rearrangement and high levels of PD-L1 expression. INTERVENTIONS The patient started first-line systemic treatment with pembrolizumab reporting stable disease; at progression, she received second-line treatment with crizotinib. The treatment was not well-tolerated, and the patient then underwent 5 cycles of ceritinib treatment. OUTCOMES The patient showed a partial response to targeted therapy. At progression, brigatinib was initiated, but the patients reported liver progression soon after the initiation of this therapy. LESSONS Molecular-driven investigation is necessary in PSC for treatment selection.
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Affiliation(s)
| | - Rita De Sanctis
- Medical Oncology and Hematology Unit, Humanitas Cancer Center
| | | | - Annarita Destro
- Pathology Department, Humanitas Clinical and Research Center – IRCCS, Rozzano
| | - Daoud Rahal
- Pathology Department, Humanitas Clinical and Research Center – IRCCS, Rozzano
| | | | - Armando Santoro
- Medical Oncology and Hematology Unit, Humanitas Cancer Center
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
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Abstract
Pulmonary sarcomatoid carcinoma (PSC) is a rare subtype of poorly differentiated non-small-cell lung cancer (NSCLC), and no effective treatment is available in clinical practice currently. In the present report, a 61-year-old male patient was hospitalized due to cough, dyspnea, and right chest pain. Computed tomography (CT) showed spot- and piece-shaped shadows. The patient became very weak and had breathing difficulty after preliminary anti-pneumonia treatment with cefoperazone-sulbactam. Physical examination revealed dull sound by percussion and decreased breath sounds in the right lateral lung areas by auscultation. A second CT scan revealed a large amount of pleural effusion, and the patient was diagnosed with bloody pleural effusion through pleural space puncture. Multiple nodular lesions were found in the right pleural cavity under thoracoscopy. PSC was confirmed by biopsy and histopathology in combination with immunohistochemistry (IHC). Single-photon emission CT (SPECT) scan indicated multiple bone metastases. KRAS exon 2 mutation and EML4-ALK fusion were identified in carcinoma tissue by IHC and amplification refractory mutation system (ARMS)-PCR. The patient received one cycle of first-line combination chemotherapy of cisplatin and paclitaxel liposomes. However, the patient did not respond to the platinum-based combination chemotherapy within 3 weeks and was thus administered oral crizotinib instead of chemotherapy. Unfortunately, he still had rapid disease progression and died 2 weeks after the initiation of crizotinib treatment. Collectively, our results suggest that a PSC patient with coexistent KRAS mutation and ALK rearrangement would not benefit from chemotherapy and tyrosine kinase inhibitor (TKI) treatment.
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Affiliation(s)
- Fangmin Chen
- Department of Respiratory Medicine, Xiangya Hospital of Central South University, Changsha, People's Republic of China,
| | - Qihua Gu
- Department of Respiratory Medicine, Xiangya Hospital of Central South University, Changsha, People's Republic of China,
| | - Chengping Hu
- Department of Respiratory Medicine, Xiangya Hospital of Central South University, Changsha, People's Republic of China,
| | - Xiaoling Cai
- Department of Respiratory Medicine, Xiangya Hospital of Central South University, Changsha, People's Republic of China,
| | - Shuhua Lei
- Department of Respiratory Medicine, Xiangya Hospital of Central South University, Changsha, People's Republic of China,
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Basu A, Moreira AL, Simms A, Brandler TC. Sarcomatoid carcinoma in cytology: Report of a rare entity presenting in pleural and pericardial fluid preparations. Diagn Cytopathol 2019; 47:813-816. [PMID: 30908904 DOI: 10.1002/dc.24183] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Revised: 02/24/2019] [Accepted: 03/14/2019] [Indexed: 01/06/2023]
Abstract
Sarcomatoid carcinoma is rarely found in pleural or pericardial fluid, with very few cases published to date. Here, we describe a 59-year-old female who presented with cough persisting for 5 months. Chest CT scan revealed a 6.0 cm cavitary mass in the left lung base with bulky mediastinal and hilar lymphadenopathy. An additional 1.2 cm right adrenal mass was seen and was suspicious for metastatic disease. The patient developed dyspnea, tachycardia, pleuritic chest pain and generalized weakness and was admitted to the hospital. She was found to have pleural and pericardial effusions, which were drained and sent to cytology. The fluid revealed enlarged highly pleomorphic malignant cells, some displaying multinucleation with irregular nuclear borders, coarse chromatin and prominent nucleoli. Tumor cells were positive for CK7 and Vimentin and negative for MOC-31, Ber-EP4, B72.3, Sox10, Melan-A, TTF-1, Napsin-A and CK20. A concurrent surgical biopsy of the tumor mass displayed immunopositivity for AE1/AE3 and CAM5.2. The tumor was negative for p40, TTF-1, calretinin, D2-40 and STAT6. A diagnosis of sarcomatoid carcinoma with giant cells and spindle cells was rendered. Sarcomatoid carcinomas of the lung are very uncommon consisting of 1% of non-small-cell lung carcinomas and are even more unusual in cytology specimens. Despite its rarity, it is important to keep this entity in mind in the differential diagnosis of a fluid specimen with bizarre nuclear atypia and the above staining pattern.
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Affiliation(s)
- Atreyee Basu
- Department of Pathology, NYU School of Medicine, New York, New York
| | - Andre L Moreira
- Department of Pathology, NYU School of Medicine, New York, New York
| | - Anthony Simms
- Department of Pathology, NYU School of Medicine, New York, New York
| | - Tamar C Brandler
- Department of Pathology, NYU School of Medicine, New York, New York
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Lin L, Huang F, Chen F, He Y, Hu J, Cao X. Anaplastic lymphoma kinase (ALK)-rearranged pulmonary pleomorphic carcinoma successfully treated with crizotinib. J Int Med Res 2018; 46:3491-3497. [PMID: 29310482 PMCID: PMC6134637 DOI: 10.1177/0300060517748262] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Accepted: 11/23/2017] [Indexed: 01/12/2023] Open
Abstract
Pulmonary pleomorphic carcinoma (PPC) is rare, and the response of patients to conventional chemotherapy is very poor. Here we present a patient with anaplastic lymphoma kinase (ALK)-rearranged advanced PPC treated with crizotinib. Computed tomography revealed a mass in the left upper lung of a nonsmoking 60-year-old woman. Pathological findings using resected tissue were consistent with PPC stage 1A, T1bN0M0. Although the patient received adjuvant radiotherapy, the disease relapsed, quickly progressed, and remained PPC according to analysis of biopsied tissue. Although negative for epidermal growth factor receptor mutations, ALK rearrangements were detected in adenocarcinoma and spindle-cell components. The patient received crizotinib therapy and achieved a partial response for 7 months. This case indicates that patients with PPC, particularly those with adenocarcinoma, may harbor an epithelial component with the ALK rearrangement. Although the progression-free survival of patients treated with crizotinib is limited, they may obtain more benefit compared with conventional chemotherapy.
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Affiliation(s)
- Liping Lin
- Department of Oncology, Panyu Central Hospital, Guangzhou, China
- Cancer Institute of Panyu, Guangzhou, China
- These authors contributed equally to this work
| | - Fuxi Huang
- Department of Oncology, Panyu Central Hospital, Guangzhou, China
- Cancer Institute of Panyu, Guangzhou, China
- These authors contributed equally to this work
| | - Fang Chen
- Department of Pathology, Panyu Central Hospital, Guangzhou, China
- Cancer Institute of Panyu, Guangzhou, China
- These authors contributed equally to this work
| | - Yan He
- Department of Oncology, Panyu Central Hospital, Guangzhou, China
- Cancer Institute of Panyu, Guangzhou, China
| | - Jiazhu Hu
- Department of Oncology, Panyu Central Hospital, Guangzhou, China
- Cancer Institute of Panyu, Guangzhou, China
| | - Xiaolong Cao
- Department of Oncology, Panyu Central Hospital, Guangzhou, China
- Cancer Institute of Panyu, Guangzhou, China
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Takeda K, Matsushita H, Kubozono M, Tanabe T, Ishikawa Y, Yamamoto T, Kozumi M, Takahashi N, Katagiri Y, Tasaka S, Fukui K, Takeda K, Fujishima F, Ichinose M, Jingu K. Definitive Chemoradiotherapy for Advanced Pulmonary Sarcomatoid Carcinoma. Intern Med 2016; 55:3325-3330. [PMID: 27853077 PMCID: PMC5173502 DOI: 10.2169/internalmedicine.55.6990] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Pulmonary sarcomatoid carcinoma is a rare subtype of non-small cell lung cancer with a poor prognosis. We herein report on a case of pulmonary sarcomatoid carcinoma that was treated successfully by concurrent chemoradiotherapy. A 65-year-old man was diagnosed to have pulmonary pleomorphic carcinoma (clinical T4N2M0 stage IIIB). He received concurrent chemoradiotherapy (60 Gy of radiotherapy in 30 fractionations and two courses of chemotherapy with carboplatin and paclitaxel). After chemoradiotherapy, a significant reduction of the tumor size was observed. Two courses of adjuvant chemotherapy were performed. He is currently alive at 15 months after the first treatment without any recurrence or metastasis.
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Affiliation(s)
- Kazuya Takeda
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Japan
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Zou F, Xie G, Ma JA, Zhou DA, Jiang YI, Zheng JY. Epidermal growth factor receptor mutation heterogeneity analysis of pulmonary sarcomatoid carcinoma successfully treated with erlotinib: A case report. Oncol Lett 2015; 9:2239-2243. [PMID: 26137049 DOI: 10.3892/ol.2015.3057] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Accepted: 02/02/2015] [Indexed: 11/06/2022] Open
Abstract
Pulmonary sarcomatoid carcinoma (PSC) is a rare histological subtype of non-small cell lung cancer, and the available studies on the response to epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs) is limited. In the present study, a 73-year-old female presented with a large mass in the lower right lung, which was diagnosed as a PSC on biopsy. An amplification-refractory mutation system (ARMS) test revealed that the patient possessed the wild-type EGFR gene, and the patient subsequently underwent radiotherapy (60 Gy) and four 21-day cycles of chemoradiotherapy (1,600 mg gemcitabine, days 1 and 8; 30 mg, cisplatin, days 1-3). Following radiotherapy and chemotherapy treatment, a CT scan revealed complete remission of the mass in the lower right lung, however, metastases were identified in the paraaortic lymph node, bilateral iliac fossa and the right gluteal region. Notably, an EGFR exon 21 L858R gene mutation was identified in the mass of the right gluteal metastasis. Therefore, treatment with erlotinib was initiated. The patient continued to experience progression-free survival for six months following the initiation of erlotinib therapy. However, multiple metastases were then identified, and all lesions possessed the wild-type EGFR gene, as identified by the ARMS test. The findings suggest that erlotinib is a viable therapeutic option for the treatment of PSC patients that possess an EGFR mutation. The spatio-temporal evolution of EGFR mutational heterogeneity in PSC may result in drug-resistance, which challenges EGFR-TKI therapy and EGFR gene mutation diagnosis.
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Affiliation(s)
- Fangwen Zou
- Department of Oncology, The Second Xiangya Hospital of Central South University, Changsha, Hunan 410011, P.R. China
| | - Guiyuan Xie
- Department of Oncology, The Second Xiangya Hospital of Central South University, Changsha, Hunan 410011, P.R. China
| | - Jin-An Ma
- Department of Oncology, The Second Xiangya Hospital of Central South University, Changsha, Hunan 410011, P.R. China
| | - Dong-Ai Zhou
- Department of Oncology, The Second Xiangya Hospital of Central South University, Changsha, Hunan 410011, P.R. China
| | - Y I Jiang
- Department of Pathology, The Second Xiangya Hospital of Central South University, Changsha, Hunan 410011, P.R. China
| | - Jiao-Yun Zheng
- Department of Pathology, The Second Xiangya Hospital of Central South University, Changsha, Hunan 410011, P.R. China
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