Wen Yingmei, Dong Yi, Yi Lina, Yang Guifang, Xiao Mengxia, Li Qingqing, Zhao Chen, Ye Dafu, Yao Yi
Cancer Center, Renmin Hospital of Wuhan University, Wuhan, China.
Department of Pathology, Zhongnan Hospital of Wuhan University, Wuhan, China.
Front Oncol. 2023 Oct 18;13:1241475. doi: 10.3389/fonc.2023.1241475. eCollection 2023.
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 , , and 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.
肺肉瘤样癌（PSC）是非小细胞肺癌（NSCLC）的一种罕见变体，以其不良预后而闻名。先前的研究表明，PSC通常表现出程序性死亡配体1（PD-L1）的显著表达、肿瘤突变负担升高以及明显的血管侵犯。这些因素暗示了免疫疗法和抗血管生成疗法等治疗方法可能有效。该病例的患者是一名65岁男性，被诊断为晚期PSC，其特征是PD-L1高表达且无已知驱动基因突变。由于2019冠状病毒病大流行带来的限制，患者最初在家接受安罗替尼治疗，一个治疗周期后症状有所改善。随后住院接受安罗替尼联合帕博利珠单抗治疗，结果为部分缓解。由于局部疾病进展，需要进行放疗。但在使用帕博利珠单抗治疗15个周期后，观察到超进展。患者的总生存期为14个月，对药物无明显不良反应。基因组分析揭示了治疗疗效与 、 和 基因中的突变之间的潜在关联。该病例强调了一线治疗方案将泛靶点抗血管生成疗法（安罗替尼）与抗肿瘤免疫疗法相结合的有效性和安全性。
