Kobayashi Nao, Sunaga Noriaki, Yatomi Masakiyo, Wakamatsu Ikuo, Muto Sohei, Ikota Hayato, Yamaguchi Rei, Ohtaki Yoichi, Nagashima Toshiteru, Kubo Nobuteru, Masuda Tomomi, Miura Yosuke, Tsurumaki Hiroaki, Sakurai Reiko, Koga Yasuhiko, Hisada Takeshi, Maeno Toshitaka
Department of Respiratory Medicine, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan.
Department of Diagnostic Pathology, Gunma University Hospital, Maebashi, Gunma, Japan.
Thorac Cancer. 2025 Jan;16(2):e15512. doi: 10.1111/1759-7714.15512. Epub 2024 Dec 27.
Histologic transformation from non-small cell to small cell lung cancer (SCLC) is a resistance mechanism to immune checkpoint inhibitors. We report herein a case of lung adenocarcinoma who developed liver and brain metastases during adjuvant atezolizumab therapy. The patient underwent a craniotomy to resect a brain metastasis, which was pathologically diagnosed as SCLC. He subsequently received platinum-based chemotherapy with durvalumab, resulting in sustained regression of the liver metastases. This case demonstrates a metastatic brain tumor-acquired resistance to atezolizumab through histologic transformation from adenocarcinoma to SCLC. Therefore, rebiopsy is needed if recurrent disease appears during immune checkpoint inhibitor treatment in patients with non-small cell lung cancer.
非小细胞肺癌向小细胞肺癌的组织学转化是对免疫检查点抑制剂的一种耐药机制。我们在此报告一例肺腺癌患者，其在辅助阿替利珠单抗治疗期间发生了肝转移和脑转移。该患者接受了开颅手术以切除脑转移瘤，病理诊断为小细胞肺癌。随后他接受了铂类化疗联合度伐利尤单抗治疗，肝转移灶持续消退。该病例显示了转移性脑肿瘤通过从腺癌向小细胞肺癌的组织学转化获得了对阿替利珠单抗的耐药性。因此，非小细胞肺癌患者在免疫检查点抑制剂治疗期间出现复发性疾病时需要重新活检。
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