Zhang Lin, Lin Weihao, Yang Zhenlin, Li Renda, Gao Yibo, He Jie
Department of Oncology, Renmin Hospital of Wuhan University, Wuhan, China.
Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
J Oncol. 2022 Mar 25;2022:8541157. doi: 10.1155/2022/8541157. eCollection 2022.
Pulmonary sarcomatoid carcinoma (PSC) is an unconventional non-small-cell lung cancer (NSCLC) that is currently managed under guidelines used for conventional NSCLC and has poor survival. Surgery is the optimal choice for resectable PSC, and the prevalence of mutations in this type of tumor laid the foundation for novel systemic therapies such as targeted therapy and immunotherapy. PSC is resistant to chemotherapy and radiotherapy, and the effects of the 2 therapies are controversial. Targeted therapies have been reported to confer survival benefits, and savolitinib, an oral selective MET tyrosine-kinase inhibitor, has been approved in metastatic patients with MET exon 14 skipping mutations. Expression and positive rate of programmed death ligand 1 in PSC are high; our previous research has also revealed a high mutational burden and a T-cell-inflamed microenvironment of PSC. Correspondingly, immune checkpoint inhibitors have shown preliminary antitumor effects (overall response rates of 40.5% (15/37) and 31.6% (6/19) in two retrospective studies, respectively) in PSC patients. In summary, patients should receive operations at an early stage and multimodality treatments are needed to maximize the benefits of patients with advanced disease.
肺肉瘤样癌（PSC）是一种非传统的非小细胞肺癌（NSCLC），目前按照常规NSCLC的指南进行管理，生存率较低。手术是可切除PSC的最佳选择，这类肿瘤中突变的发生率为新型全身治疗（如靶向治疗和免疫治疗）奠定了基础。PSC对化疗和放疗耐药，这两种治疗方法的效果存在争议。据报道，靶向治疗可带来生存获益，口服选择性MET酪氨酸激酶抑制剂赛沃替尼已被批准用于治疗具有MET外显子14跳跃突变的转移性患者。PSC中程序性死亡配体1的表达及阳性率较高；我们之前的研究还揭示了PSC的高突变负荷和T细胞炎症微环境。相应地，免疫检查点抑制剂在PSC患者中已显示出初步的抗肿瘤效果（两项回顾性研究中的总缓解率分别为40.5%（15/37）和31.6%（6/19））。总之，患者应早期接受手术，对于晚期疾病患者，需要采取多模式治疗以实现最大获益。
