Case Report: Pulmonary sarcomatoid carcinoma complicating TP53 mutation treated successfully with Tislelizumab combined with Anlotinib—a case report

Abstract

Pulmonary sarcomatoid carcinoma (PSC) is a rare subtype of lung malignant tumor. Conventional chemotherapy has a suboptimal effectiveness. PSC has the characteristics of rapid disease progression and poor prognosis. We herein report a 56-year-old male patient with substantial smoking history was pathologically diagnosed as PSC, cT4N0M0 IIIA stage. Peripheral blood NGS showed TP53 mutation. The patient had poor tolerance to the first-line chemotherapy regimen “albumin paclitaxel + cisplatin,” but the severe anemia was significantly improved after 5 days of anti-angiogenic therapy with Anlotinib. At this time, the patient received anti-PD-1 immunotherapy with Tislelizumab. Half a month later, degree III liver injury occurred repeatedly. After excluding drug-induced liver injury, we found that HCV-RNA 3.10 × 105 IU/ml and suspended all anti-tumor therapy. After the start of anti-HCV treatment with Epclusa, the treatment of Tislelizumab combined with Anlotinib was restarted, and there was no liver injury after that. The patient received monthly maintenance therapy with Tislelizumab combined with Anlotinib to the present. The pulmonary lesions continued to decrease, and only one lung cavity is left. The patient has achieved clinical complete remission (CCR) with PSF over 20 months. Our findings suggest that Tislelizumab combined with Anlotinib may be a preferred strategy in PSC complicating TP53 mutation. Core tip: Immune-check point inhibitors (ICIs) have been reported for the treatment of PSC in a small number of case reports and retrospective analysis, but there are few reports of ICIs combined with anti-angiogenic drugs. This patient was diagnosed as locally advanced PSC complicated with TP53 mutation and hepatitis C. After 14 cycles of Tislelizumab combined with Anlotinib treatment (during the course of treatment, several courses were not treated on time for economic reasons, rather than adverse reactions), the patient has achieved CCR. III degree liver injury occurred during the treatment, and the liver function returned to normal range after anti-hepatitis C treatment, which did not affect the continued treatment of this regimen.

Sintilimab combined with anlotinib as first-line treatment for advanced sarcomatoid carcinoma of head and neck: a case report and literature review

“…Doomblides, C et al showed a report on LSC that patients with high TMB had a median OS of 18 months, while the low TMB population had only 1.84 months (49). Other case reports of sarcomatoid carcinoma have also shown a longer survival time with a higher TMB (32,43,37,38).The median value of TMB in patients with sarcomatoid carcinoma of the head and neck was 4.34 (0.71-14.71) muts/Mb, and TMB was significantly higher in patients with advanced stages compared to those with early stages (20). However, the relationship between TMB and immunotherapy in patients with sarcomatoid carcinoma of the head and neck has not been confirmed.…”

“…reported sustained remission in patients with advanced LSC through the application of apatinib in combination with chemotherapy ( 53 ). In addition, anlotinib has exhibited positive clinical outcomes in patients with LCS ( 32 , 43 ). Anlotinib, a new oral tyrosine kinase inhibitor (TKI), targets platelet-derived growth factor receptor, fibroblast growth factor receptor, and vascular endothelial growth factor receptor.…”

Biological characteristics and clinical treatment of pulmonary sarcomatoid carcinoma: a narrative review

“…For advanced NSCLC, chemotherapy nonetheless retains an indispensable role. However, several cases suggest that PSC is insensitive to chemotherapy ( 58 , 107 - 109 ).…”

“…In some case reports, antiangiogenic therapy combined with immunotherapy provided promising results. A chemoresistant patient achieved CR over 20 months after treatment with tislelizumab plus anlotinib ( 109 ). Similarly, good efficacy was observed in cases treated with anlotinib combined with nivolumab ( 155 ), camrelizumab ( 156 ), or pembrolizumab ( 157 ).…”

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

“…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.…”