Cheng Yurong, Yang Jiandong, Wang Daochao, Yan Dong
Department of Oncology, Beijing Luhe Hospital, Capital Medical University, Beijing, China.
Ann Transl Med. 2022 Feb;10(3):157. doi: 10.21037/atm-21-6754.
rearrangements are validated drivers in non-small cell lung cancer (NSCLC), and occur at an extremely low rate in rare pathological subtypes such as adenosquamous carcinoma (ASC). Crizotinib is known to be effective in patients with -rearranged NSCLC. However, the efficacy of crizotinib in patients with -rearranged lung ASC is unknown. Here, we report the case of a 43-year-old female never-smoker who presented with dry cough for 3 months. The patient was then diagnosed with stage IIIA poorly-differentiated lung ASC with rearrangement (). Programmed death-ligand 1 (PD-L1) expression was high with 50% in tumor cells of her lung puncture biopsy sample. The patient received albumin-bound paclitaxel and camrelizumab as the first-line treatment and achieved a stable disease (SD) response with progression-free survival (PFS) of 2 months. Subsequently, the patient received crizotinib as the second-line treatment and achieved a partial response (PR) with PFS of 4 months. No gene mutation other than (C6:R34) rearrangement was detected from the lung biopsy sample after crizotinib resistance using a panel covering 520 cancer-related genes. We speculate that crizotinib may have a short duration of efficacy against lung ASC. This is the first case report of response to crizotinib for a lung ASC patient with fusion, and may help future targeted therapy investigations and prognostic evaluation for patients with rare pathological subtypes of NSCLC.
重排是非小细胞肺癌（NSCLC）中已被证实的驱动因素，在腺鳞癌（ASC）等罕见病理亚型中发生率极低。已知克唑替尼对ALK重排的NSCLC患者有效。然而，克唑替尼对ALK重排的肺ASC患者的疗效尚不清楚。在此，我们报告一例43岁从不吸烟的女性患者，其干咳3个月。该患者随后被诊断为伴有ALK重排（EML4-ALK）的IIIA期低分化肺ASC。程序性死亡配体1（PD-L1）表达较高，其肺穿刺活检样本的肿瘤细胞中为50%。患者接受白蛋白结合型紫杉醇和卡瑞利珠单抗作为一线治疗，达到疾病稳定（SD）反应，无进展生存期（PFS）为2个月。随后，患者接受克唑替尼作为二线治疗，达到部分缓解（PR），PFS为4个月。在使用覆盖520个癌症相关基因的检测板对克唑替尼耐药后的肺活检样本进行检测后，未检测到除EML4-ALK（C6：R34）重排以外的其他基因突变。我们推测克唑替尼对肺ASC的疗效持续时间可能较短。这是首例关于ALK融合的肺ASC患者对克唑替尼有反应的病例报告，可能有助于未来对NSCLC罕见病理亚型患者的靶向治疗研究和预后评估。
