Piao Mei-Na, Ma Xiao-Ting, Tankere Pierre, Liam Chong-Kin, Li Jin-Li, Wang Jian-Ping
Department of Radiation Oncology, The Affiliated Hospital of Soochow University, Suzhou, China.
Reference Center for Rare Pulmonary Diseases, Pulmonary Medicine and Intensive Care Unit Department, Dijon University Hospital, Dijon, France.
Ann Transl Med. 2022 Sep;10(18):1030. doi: 10.21037/atm-22-4312.
Pulmonary sarcomatoid carcinoma (PSC) is a rare disease which is highly malignant with a poor prognosis. PSC is highly resistant to chemotherapy and radiotherapy and is prone to recurrence even after surgery. Most of what is known about PSC comes from limited single-center, retrospective studies. There is still no standard international clinical guideline for PSC. Limited case reports have shown that PSC patients with driver gene mutations and high programmed death-ligand 1 (PD-L1) expression have good responses to molecular targeted therapy and immune checkpoint inhibitor (ICI) immunotherapy, respectively. Therefore, current first-line chemotherapy, targeted therapy and immunotherapy play a leading role in the diagnosis and treatment of advanced PSC patients.
We report a 42-year-old male who was diagnosed with PSC [stage IVB (T4N2M1)] and treated at our department (Department of Radiation Oncology, The Affiliated Hospital of Soochow University). The initial computed tomography (CT) scan of the chest showed a large mass (159 mm × 112 mm) which on needle biopsy showed sarcomatoid carcinoma histology. The patient received 8 cycles of abraxane plus cisplatin chemotherapy combined with anlotinib and immunotherapy, followed by immunotherapy and anlotinib for >1 year. Finally, the local tumor was well controlled, and no obvious drug-related adverse reactions were observed. The large lesions in the lung remained in complete response for >24 months.
To our knowledge, this is the first reported case of an advanced PSC patient showing a good response to the treatment consisting of anlotinib combined with sintilimab and platinum-doublet chemotherapy. This case suggests that chemotherapy combined with antiangiogenic therapy and immunotherapy may benefit patients with advanced PSC. Long-term immunotherapy and anlotinib maintenance therapy has been safe and effective in our case. However, randomized controlled clinical studies are needed to confirm the efficacy and safety of these treatment options.
肺肉瘤样癌（PSC）是一种罕见疾病，恶性程度高，预后差。PSC对化疗和放疗高度耐药，即使手术后也容易复发。目前关于PSC的大部分认知来自有限的单中心回顾性研究。PSC仍没有标准的国际临床指南。有限的病例报告显示，具有驱动基因突变和高程序性死亡配体1（PD-L1）表达的PSC患者分别对分子靶向治疗和免疫检查点抑制剂（ICI）免疫治疗有良好反应。因此，目前一线化疗、靶向治疗和免疫治疗在晚期PSC患者的诊断和治疗中发挥主导作用。
我们报告一名42岁男性，被诊断为PSC [IVB期（T4N2M1）]并在我院（苏州大学附属第一医院放疗科）接受治疗。胸部最初的计算机断层扫描（CT）显示一个大肿块（159 mm×112 mm），针吸活检显示为肉瘤样癌组织学。患者接受了8个周期的白蛋白结合型紫杉醇加顺铂化疗联合安罗替尼和免疫治疗，随后接受免疫治疗和安罗替尼治疗超过1年。最后，局部肿瘤得到良好控制，未观察到明显的药物相关不良反应。肺部的大病灶完全缓解超过24个月。
据我们所知，这是第一例报告的晚期PSC患者对安罗替尼联合信迪利单抗和铂类双药化疗治疗有良好反应的病例。该病例表明，化疗联合抗血管生成治疗和免疫治疗可能使晚期PSC患者受益。在我们的病例中，长期免疫治疗和安罗替尼维持治疗一直安全有效。然而，需要随机对照临床研究来证实这些治疗方案的疗效和安全性。
