Anlotinib combined with chemotherapy and immunotherapy for advanced pulmonary sarcomatoid cancer: a case report and literature review

Piao, Mei-Na; Ma, Xiaoting; Tankere, Pierre; Liam, Chong Kin; Li, Jinli; Wang, Jianping

doi:10.21037/atm-22-4312

Cited by 5 publications

(4 citation statements)

References 33 publications

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“…PSC is a rare and poorly differentiated NSCLC, which is commonly accompanied by sarcoma or sarcomatoid components, characterized by rapid proliferation, high vascular invasion and epithelial-mesenchymal transition. Many previous case reports have shown that compared with surgical resection or combined chemotherapy, combination therapy with TKIs and ICIs have promising efficacy in patients with PSC, significantly improving the progression free survival (PFS) and overall survival (OS) of patients, and some even achieve PR ( 8 , 11 ).…”

Section: Discussionmentioning

confidence: 99%

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Case report: Sintilimab combined with anlotinib as neoadjuvant chemotherapy for metastatic bone tumor resection in patients with PSC

Bao,

Yu,

Zheng

et al. 2024

Front. Immunol.

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BackgroundPulmonary sarcomatoid carcinoma (PSC) is a rare subtype of non-small-cell lung cancer (NSCLC), which is resistant to chemotherapy and radiotherapy with a poor prognosis. PSC is highly malignant and is prone to recurrence even after surgery. The programmed death-ligand 1 (PD-L1) tumor cell proportion score (TPS) 5%, TERT and TP53 gene mutations were detected in this patient accompanied by multiple metastatic sites. The anlotinib is a novel multitarget tyrosine kinase inhibitor (TKI) that could be effective for advanced NSCLC and some sarcoma patients. Limited clinical trials and case reports have shown that PSC patients with gene mutations and PD-L1 expression have good responses to multitarget antiangiogenic drug and immune checkpoint inhibitors (ICIs). In this article, we reported a case with metastatic PSC diagnosed by Computed Tomography (CT)-guided needle biopsy treated with immunotherapy combined with antiangiogenic drugs as a neoadjuvant chemotherapy (NACT). PSC is controlled and the patient achieves successfully limb salvage treatment by surgical resection. Therefore, targeted therapy and immunotherapy can provide sufficient surgical opportunities for limb salvage in the treatment of metastatic PSC patients.Case summaryA 69-year-old male diagnosed with malignant bone tumor in the proximal femur was admitted to our hospital in June 2022 with recurrent fever as well as swelling and pain in the left thigh for twenty days. The initial computed tomography (CT) scan of the chest showed a pulmonary cavity (20 mm × 30 mm) and scattered lung masses. Subsequently, he underwent a CT-guided needle biopsy to distinguish the essence of osteolytic bone destruction and soft tissue mass in the left proximal femur which showed metastatic sarcomatoid carcinoma histology. Genetic testing revealed TERT c.-124C mutation (abundance 8.81%), TP53 p.R342 mutation (abundance 11.35%), tumor mutational burden (TMB) 7.09 muts/Mb, microsatellite stability (MSS), and PD-L1 (SP263) TPS 5% were also detected. The patient was tentatively treated with a combination of antiangiogenic drug and PD-1 inhibitor. After one course, the tumor volume significantly reduced in magnetic resonance imaging (MRI) and pathological fracture occurred in the femur after combined treatment. The patient received proximal femoral tumor resection and prosthesis replacement after defervescence. Sequentially sintilimab with anlotinib were administered for over 1 year. Finally, the local tumor was well controlled, and no obvious drug-related adverse reactions were observed. The lesions in the lung remained in partial response (PR) for more than 16 months and complete response (CR) of metastatic tumor in the proximal femur was observed through imaging examinations.ConclusionThis is the first reported case of a metastatic PSC in femur showing a favorable response to the treatment consisting of anlotinib combined with sintilimab. This case suggests that antiangiogenic therapy combined with immunotherapy may benefit patients with metastatic PSC in the preoperative adjuvant therapy for limb salvage.

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Section: Discussionmentioning

confidence: 99%

“…ICIs can improve the prognosis of patients with advanced NSCLC. The high expression of PD-L1 and proportion of patients with high TMB are relatively common in PSC compared with other subtypes ( 8 ). It has been reported that among PSC patients, over 50% showed positive PD-L1 expression ( 12 ).…”

Section: Discussionmentioning

confidence: 99%

Case report: Sintilimab combined with anlotinib as neoadjuvant chemotherapy for metastatic bone tumor resection in patients with PSC

Bao,

Yu,

Zheng

et al. 2024

Front. Immunol.

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“… 104 In another patient with advanced PSC but negative PD-L1 expression, combination therapy with atezolizumab, bevacizumab, carboplatin, and paclitaxel (ABCP) resulted in marked shrinkage of the tumor, and continued shrinkage was observed during maintenance therapy with atezolizumab and bevacizumab. 105 Other combinations, including anlotinib plus tislelizumab 106 or sintilizumab, 107 have also been reported to be effective.…”

Section: Efficacy Of Fda-approved Targeted Therapiesmentioning

confidence: 99%

Targeted therapy for rare lung cancers: Status, challenges, and prospects

2023

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“…One study showed that patients with PSC treated with chemotherapy combined with immunotherapy as first-line therapy achieved an objective response rate (ORR) of 73.8% and a median progression-free survival (mPFS) of 10.3 months (6). There are also some case reports that the use of targeted drugs significantly alleviates disease and even survival benefits in patients with PSC (7)(8)(9). Thus, immunotherapy and targeted therapy may offer new opportunities for the treatment of PSC.…”

Section: Introductionmentioning

confidence: 99%

An advanced pulmonary sarcomatoid carcinoma patient harboring a BRAFV600E mutation responds to dabrafenib and trametinib: a case report and literature review

2023

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BackgroundThe pulmonary sarcomatoid carcinoma (PSC) is a rare and aggressive subtype of NSCLC with rapid progression and poor prognosis, and is resistant to conventional chemotherapy. Most PSC cases have potential targetable genomic alterations. Approximately 7% of PSC patients have BRAF mutations, and the efficacy of dabrafenib and trametinib in BRAFV600E mutated PSC is unclear.Case presentationOur report describes a patient with mutated BRAFV600E PSC who underwent surgery and adjuvant chemotherapy early but quickly relapsed. Both chemotherapy and immunotherapy were ineffective for him, combined dabrafenib and trametinib produced a 6-month progression-free survival, and a partial response was observed in the tumor response evaluation. As a result of financial pressure, he stopped taking the targeted drugs, and his disease rapidly progressed.ConclusionDabrafenib combined with trametinib provides partial remission in patients with advanced PSC with BRAFV600E mutations, and large-scale NGS panels could offer more options for PSC treatment.

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Anlotinib combined with chemotherapy and immunotherapy for advanced pulmonary sarcomatoid cancer: a case report and literature review

Cited by 5 publications

References 33 publications

Case report: Sintilimab combined with anlotinib as neoadjuvant chemotherapy for metastatic bone tumor resection in patients with PSC

Case report: Sintilimab combined with anlotinib as neoadjuvant chemotherapy for metastatic bone tumor resection in patients with PSC

Targeted therapy for rare lung cancers: Status, challenges, and prospects

An advanced pulmonary sarcomatoid carcinoma patient harboring a BRAFV600E mutation responds to dabrafenib and trametinib: a case report and literature review

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