Combination of Pembrolizumab With Platinum-containing Chemotherapy for Pleomorphic Carcinoma of the Lung

Abstract

Background/Aim: Pleomorphic carcinoma of the lung is a rare, highly malignant subtype of lung cancer, with a more aggressive clinical course compared with other types of non-small-cell lung cancer (NSCLC). Platinum-containing chemotherapy has been the standard therapy for patients with NSCLC and pembrolizumab is one of the novel and reliable agents for these patients. Case Report: We herein report the case of a 60-year-old man with advanced chemo-naïve pleomorphic carcinoma of the lung who was successfully treated with a combination of pembrolizumab with platinumcontaining chemotherapy. Conclusion: In the absence of definitive clinical trials, which are unlikely to be performed due to the rarity of this tumor, our case demonstrates the potential utility of the combination of pembrolizumab with platinum-containing chemotherapy. Our result also suggest that this combination of therapy may be key to the treatment of pleomorphic carcinoma of the lung. Pleomorphic carcinoma of the lung is a rare, highly malignant tumor, accounting for 0.1-0.4% of all primary lung cancer cases (1-3). It has a more aggressive clinical course compared with other types of non-small-cell lung cancer (NSCLC) (4-6), as well as a poorer outcome (4, 7, 8).

Pulmonary Pleomorphic Carcinoma Harboring EGFR Mutation Successfully Treated with Osimertinib: A Case Report

“…Although the efficacy of platinum-based chemotherapy for PPC is unsatisfactory leading to poor prognosis [1,2], the efficacy of ICI monotherapy [3][4][5][6] or chemoimmunotherapy [7] has been elucidated. The efficacy of these treatment regimens is linked to the abovementioned high expression of PD-L1 in PPC.…”

“…Pulmonary pleomorphic carcinoma (PPC) is a very rare type of poorly differentiated non-small cell lung cancer (NSCLC) with an aggressive nature [1] that is usually resistant to platinum-based chemotherapy [1,2]. On the other hand, the efficacy of immune checkpoint inhibitor (ICI) monotherapy [3][4][5][6] or chemoimmunotherapy [7] in PPC has been elucidated, which led to improved outcomes. Although epidermal growth factor receptor (EGFR) mutations are found in approximately 15-20% of PPCs [8,9], the efficacy of EGFR-tyrosine kinase inhibitors (EGFR-TKIs) in PPC is limited compared to their efficacy in EGFR-mutated adenocarcinoma [8].…”

Case Series of Pleomorphic Carcinoma of the Lung Treated With Immune Checkpoint Inhibitors

“…While the response to cytotoxic agents is reported to be poor in patients with pleomorphic carcinoma of the lung (2-4), there have been several reports of cases treated successfully with immune checkpoint inhibitors (8)(9)(10)(11)(12). Although publication bias should be considered, immune checkpoint inhibitors are expected to be effective against pleomorphic carcinoma of the lung.…”

Efficacy of immune checkpoint inhibitor therapy in patients with pulmonary sarcomatoid carcinoma in clinical practice

“… 7 , 8 There are also a few case reports suggesting the efficacy of ICI therapy in patients with pulmonary sarcomatoid carcinoma. 9 , 10 , 11 , 12 , 13 , 14 , 15 In some of these case reports, the treatment duration with ICIs exceeded 6 months. However, on account of publication bias, evaluation of consecutive cases would be desirable to confirm the efficacy of ICI therapy in patients with pulmonary sarcomatoid carcinoma.…”

“…Pembrolizumab monotherapy, however, was associated with a 5‐year survival rate of 31.9% in patients with NSCLC showing strong tumor expression of programmed death ligand‐1 (PD‐L1) 6 and combined therapy with ICIs and cytotoxic agents has been shown to be effective, regardless of the tumor PD‐L1 expression status 7,8 . There are also a few case reports suggesting the efficacy of ICI therapy in patients with pulmonary sarcomatoid carcinoma 9–15 . In some of these case reports, the treatment duration with ICIs exceeded 6 months.…”