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.
Front Immunol. 2022 Oct 31;13:956982. doi: 10.3389/fimmu.2022.956982. eCollection 2022.
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.
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.
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 ( = 0.86 and = 0.34, respectively) and different immunotherapies ( = 0.10 and = 0.23, respectively). No serious adverse events (grade ≥ 3) were noted.
First-line immunotherapy has promising therapeutic potential in the treatment of PSC. More studies are warranted to confirm these findings.
肺肉瘤样癌（PSC）是一种罕见且侵袭性强的疾病，目前尚无标准化的治疗策略。最近的研究已经证明二线或以上免疫检查点抑制剂（ICI）的疗效，而 PSC 的一线免疫治疗的证据仍然仅限于病例报告，并且了解甚少。
这是一项多中心、回顾性分析，纳入了 21 例于 2019 年 1 月至 2022 年 3 月期间接受 ICI 作为一线治疗的组织学诊断为 PSC 的患者。使用单克隆抗体 22C3 通过免疫组化（IHC）评估 PD-L1 的表达。使用肿瘤比例评分（TPS）定义低和高 PD-L1 表达，截断值分别为 1%和 50%。
所有 8 例接受 PD-L1 表达评估的患者均为 PD-L1 阳性，其中 6 例（6/8，75.0%）为高 PD-L1 表达。在 21 例 PSC 患者中，7 例接受了替雷利珠单抗治疗，6 例接受了卡瑞利珠单抗治疗，4 例接受了信迪利单抗治疗，3 例接受了帕博利珠单抗治疗，1 例接受了度伐利尤单抗治疗。其中，18 例 PSC 患者接受了联合治疗，另有 3 例 PSC 患者接受了免疫单药治疗。在 21 例 PSC 患者中，12 例（57.1%）获得部分缓解（PR），5 例患者的最佳缓解为疾病稳定（SD），4 例 PSC 患者出现明显的疾病进展（PD）。中位无进展生存期（PFS）为 9.2（95%CI[4.3，14.1]）个月，中位总生存期（OS）为 22.8（95%CI[4.0，41.5]）个月。在 3 个治疗组（免疫单药治疗、免疫联合安罗替尼治疗和化疗联合免疫治疗）中，中位 PFS 分别为 8.0、9.4 和 9.6 个月，中位 OS 分别为 19.0、22.8 和 30.6 个月。3 个治疗方案组之间（ = 0.86）和不同免疫治疗之间（ = 0.34）的 PFS 和 OS 差异均无统计学意义。未观察到严重不良事件（≥3 级）。
一线免疫治疗在 PSC 的治疗中具有良好的治疗潜力。需要进一步的研究来证实这些发现。
