A Case of Lung Adenocarcinoma with Marked Improvement of Pulmonary Lymphangitic Carcinomatosis by Adding Bevacizumab to Cisplatin and Pemetrexed

Abstract

A 40-year-old man with a diagnosis of lung adenocarcinoma (cT4N3M1c, stage IVB) experienced worsening of lymphangitic carcinomatosis in the right lung and right pleural effusion after receiving 1 cycle of first-line chemotherapy consisting of cisplatin and pemetrexed. Bevacizumab was thus added from the second cycle of the cisplatin-pemetrexed regimen, leading to a marked improvement in pulmonary lymphangitic carcinomatosis and a decrease in pleural effusion. Subsequently, maintenance therapy consisting of pemetrexed and bevacizumab was continued, successfully leading to long-term progression-free survival. Generally, pulmonary lymphangitic carcinomatosis shows poor prognosis because of poor response to chemotherapy. However, recent studies have been elucidating the role of the vascular endothelial growth factor A (VEGF-A)/VEGF receptor-2 pathway in pulmonary lymphangitic carcinomatosis. Therefore, bevacizumab is expected to be beneficial in the treatment of this pathological condition.

Prognosis of pulmonary lymphangitic carcinomatosis in patients with non-small cell lung cancer

“…PLC in lung cancer has been realized as a marker of disseminated disease with a poor response to chemotherapy (21,22). Although combination chemotherapy prolonged OS in a reported case with PLC confined to a different ipsilateral lobe (23), the prognosis is generally very poor (median survival 2-13 months) and has not improved much over time (24,25). These results suggested that the prognosis of PLC may vary by histology of the tumor and the definition of PLC.…”

Genomic profiling of non-small cell lung cancer with the rare pulmonary lymphangitic carcinomatosis and clinical outcome of the exploratory anlotinib treatment

“…This was also indicated by the improvements in the mPFS and mOS in the Anlotinib group compared to those in the Other group ( Figure S3 ). Moreover, after reviewing previously reported cases ( 11 – 13 , 29 , 30 ), we calculated an ORR of 50% in gefitinib-treated patients with EGFR mutations ( 12 ), which was 100% in our study ( Table 2 ). Apatinib-based treatment was reported to demonstrate a DCR of 69.2%, mPFS of 5.2 months, and mOS of 10.2 months ( 7 ) when not distinguishing patients’ baseline characteristics, treatment lines and strategies.…”

The Effect of Lymphangitis Carcinomatosa on the Stage, and Survival in the Primary Lung Cancers

“…Yapılan çalışmalarda kanserli hastalarda görülme oranının %1'in altında olduğu bildirilmekle beraber, görülme oranının %6 ile 8 arasında değiştiğini bildiren çalışmalar da vardır. 2,4,13,14 Bizim çalışmamızda LK görülme oranı %8 idi ve literatür ile uyumluydu.…”

“…nin antegrad yoldan akciğer lenfatikleri boyunca yayılabileceği veya akciğerin vasküler yapılarından tümöral embolilerin ekstravazasyon ile lenfatikleri infiltre etmesi ile LK'nın ortaya çıkabileceği de ileri sürülmüştür. 1,2 Hangi yolla olursa olsun sonuç olarak tümör hücrelerinin lenfatik sistemin düşük basınçlı özelliğinden dolayı tutunmaları ve çoğalmaları nispeten kolay olduğu ve malign tümör hücrelerinin ürettiği vasküler endotelyal büyüme faktörünün (VEGF) etkisi ile tümör hücreleri perilenfatik peribronşial bağ dokusunun infiltrasyonunun hızlanacağı öne sürülmektedir. 3,4 Radyolojik olarak klasik görünüm peribronkovasküler-interlobüler düzensiz, nodüler kalınlaşmalardır.…”