Clinical outcomes of immune checkpoint inhibitor therapy for advanced lung adenosquamous carcinoma

Wei, Jingwen; Xiang, Jing; Hao, Yue; Si, Jinfei; Gu, Xiaodong; Xu, Manyi; Song, Zhengbo

doi:10.21037/jtd-22-1011

Cited by 5 publications

(5 citation statements)

References 26 publications

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“…However, in this case, it is noteworthy that the primary lesions of the patients showed a higher response rate than the lymph nodes, which was possibly attributable to differences in the molecular composition of the tumors (24). It is also possible that Ki-67 expression in primary tumors is higher than the expression in the lymph nodes (25). Enhanced blood supply in primary tumors improves the delivery and efficacy of chemotherapy and targeted therapy drugs, while poorer blood flow to the lymph nodes may restrict drug access, serving as another possible reason for this discrepancy (26).…”

Section: Discussionmentioning

confidence: 70%

Effective neoadjuvant immunotherapy and chemotherapy in stage IIIA adenosquamous carcinoma of the lung with a complete response and surgical success: A case report

Song,

Nie,

Liu

et al. 2024

Oncol Lett

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There has been rapid advancement in the development of neoadjuvant therapy for non-small cell lung cancer (NSCLC), which holds great promise as an effective treatment strategy. Some clinical trials have confirmed that immunotherapy in combination with chemotherapy can be a recommended first-line regimen for neoadjuvant treatment of NSCLC. The present study describes the case of a male patient aged 65 years who was diagnosed with stage IIIA (cT2N2M0) adenosquamous carcinoma of the lung. After the administration of two cycles of neoadjuvant immunotherapy (sintilimab) in combination with chemotherapy, stable disease was observed in the primary tumor, whereas partial remission was detected in the mediastinal lymph nodes based on imaging assessment. The patient underwent an immediate upper lobectomy of the left lung. Pathological analysis revealed a complete response in the primary lesion, with only minimal presence of tumor cells observed in the lymph nodes surrounding the mediastinum and bronchi. This indicated that the present neoadjuvant therapy could be used in the treatment of stage III adenosquamous lung carcinoma; however, to conclusively determine its efficacy, further studies targeting this specific cancer type are essential.

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Section: Discussionmentioning

confidence: 70%

Effective neoadjuvant immunotherapy and chemotherapy in stage IIIA adenosquamous carcinoma of the lung with a complete response and surgical success: A case report

Song,

Nie,

Liu

et al. 2024

Oncol Lett

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“…Bsides, the efficacy in lung ASC of third generation TKI such as osimertinib and ceritinib still needs further study ( 25 , 26 ). Immunotherapy has shown promising prospects in the treatment of lung ASC ( 5 ).…”

Section: Discussionmentioning

confidence: 99%

“…The prognosis for ASC patients is generally poorer compared to those with pure adenocarcinoma or squamous cell carcinoma, reflecting its more aggressive biological behavior and limited treatment options. Although immunotherapy improves survival of ASC patient, compared to squamous cell carcinoma and adenocarcinoma, ASC patients have a worse prognosis ( 3 – 5 ).…”

Section: Introductionmentioning

confidence: 99%

Efficacy of epidermal growth factor receptor-tyrosine kinase inhibitor for lung adenosquamous cell carcinoma harboring EGFR mutation: a retrospective study and pooled analysis

Xia,

Du,

Zhang

et al. 2024

Front. Oncol.

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ObjectivesTo explore the efficacy of epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs) on lung adenosquamous cell carcinoma (ASC) with EGFR mutation.MethodsEfficacy of EGFR-TKIs in the treatment of advanced or recurrent lung ASC with EGFR mutations was assessed retrospectively in 44 patients. Pooled analysis of 74 patients using EGFR-TKIs, including 30 patients selected from 11 publications, was conducted.ResultsIn our retrospective research, patients treated with EGFR-TKI in ASC with EGFR mutations had objective response rate (ORR) of 54.5%, disease control rate (DCR) of 79.5%, median progression free survival (mPFS) of 8.8 months, and median overall survival (mOS) of 19.43 months, respectively. A pooled analysis reveals ORR, DCR, mPFS, and mOS are, respectively, 63.4%, 85.9%, 10.00 months, and 21.37 months for ASC patients. In patients with deletions in exon 19 and exon 21 L858R mutations, mPFS (11.0 versus 10.0 months, P=0.771) and mOS (23.67 versus 20.33 months, P=0.973) were similar. Erlotinib or gefitinib-treated patients had an overall survival trend that was superior to that of icotinib-treated patients.ConclusionsASC harboring EGFR mutations can be treated with EGFR-TKI in a similar manner to Adenocarcinoma (ADC) harboring EGFR mutations. There is still a need for further investigation to identify the separate roles of ASC’s two components in treating EGFR.

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“…We speculate that chemotherapy may be more effective in treating primary lung tumors with SQCC components which did not respond well to ALK -TKIs. Recent studies with small sample sizes have also looked at potential therapies for advanced ASC, such as immune checkpoint inhibitor therapy ( 28 ) and pemetrexed-based therapy ( 29 ). Further cases and investigations are needed to certify.…”

Section: Discussionmentioning

confidence: 99%

Case Report: Response to ALK-TKIs in a metastatic lung cancer patient with morphological heterogeneity and consistent molecular features

Liang

Liu

et al. 2023

Front. Oncol.

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Lung adenosquamous carcinoma (ASC) is a rare heterogeneous tumor containing two distinct components of adenocarcinoma (ADC) and squamous cell carcinoma (SQCC). The limited biopsy sampling of the primary tumor might have overlooked either the ADC component or the SQCC component, resulting in a misdiagnosis of pure histology. Genotyping for driver mutations is now routinely performed in clinical settings to identify actionable oncogenic mutations and gene arrangements. Additionally, somatic mutations can potentially serve as a marker of clonal relationships. We report a rare case of ASC lung cancer, in which metastases were identified as ADC, while the primary was initially diagnosed as SQCC based on a fibrobronchoscope brush biopsy. The primary and metastatic tumors shared ALK rearrangement and other mutations support they were derived from a single clone origin. Our hypothesis is that the primary tumor contained a minor component of ADC that was not present in the histologic sections of lung biopsy. After sequential ALK-tyrosine kinase inhibitor (TKI) targeted therapy, both the patient’s primary lung tumor and the site of metastatic subcutaneous nodules decreased in size, with the metastatic sites demonstrating more noticeable shrinkage. However, after 11 months of targeted therapy, the patient was found to be resistant to ALK-TKIs. Subsequently, the patient’s respiratory status deteriorated rapidly, and a cycle of immunotherapy and chemotherapy did not show efficacy. To the best of our knowledge, this is a very rare case of lung ASC, disseminated metastasizing, with distinct morphology between the primary and metastases. Different therapeutic effects of ALK-TKIs were observed in two different morphological sites, with the metastatic cutaneous lesions shrinking more significantly than the primary lung lesions, though they both harbor the same EML4-ALK rearrangement. This case may provide diagnostic and therapeutic insights into lung ASC.

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Clinical outcomes of immune checkpoint inhibitor therapy for advanced lung adenosquamous carcinoma

Abstract: Contributions: (I) Conception and design: Z Song, J Wei; (II) Administrative support: Z Song; (III) Provision of study materials and patients: Z Song;

Cited by 5 publications

References 26 publications

Effective neoadjuvant immunotherapy and chemotherapy in stage IIIA adenosquamous carcinoma of the lung with a complete response and surgical success: A case report

Effective neoadjuvant immunotherapy and chemotherapy in stage IIIA adenosquamous carcinoma of the lung with a complete response and surgical success: A case report

Efficacy of epidermal growth factor receptor-tyrosine kinase inhibitor for lung adenosquamous cell carcinoma harboring EGFR mutation: a retrospective study and pooled analysis

Case Report: Response to ALK-TKIs in a metastatic lung cancer patient with morphological heterogeneity and consistent molecular features

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