Lazarus-Type Tumour Response to Therapy with Nivolumab for Sarcomatoid Carcinomas of the Lung

Abstract

Pulmonary sarcomatoid carcinoma (psc) is a rare subtype of non-small-cell lung carcinoma with a poor prognosis and poor response to chemotherapy and radiotherapy. A previous study reported that psc expresses high levels of PD-L1, suggesting the potential efficacy of immune checkpoint inhibitors in these tumours. We report 2 cases of patients with a lung sarcomatoid carcinoma. Both patients initially underwent curative lung resection, but developed early recurrent disease. Because PD-L1 was highly expressed in the tumour cells, we initiated therapy with nivolumab, which showed good efficacy, almost complete radiologic tumour remission, and a remarkable improvement in the condition of those patients. Immune checkpoint inhibitors targeting PD-1 might be a valuable therapy option for pscs.

Pulmonary sarcomatoid carcinoma: progress, treatment and expectations

“…Thus, PD-1/PD-L1 immunotherapy might be one of the most effective ways to treat this disease. 81 Some researchers believed that PSC patients had significant differential expression of PD-L1 compared with that of NSCLC patients. When PD-L1 is negative, immunotherapy can still be effective due to the interaction between the immune system and the tumor.…”

“…The patients still recovered well after a year of follow up. 66 , 76 , 81 However, another study showed one patient with stage IV disease, who had received first-line and second-line chemotherapy, gained no benefit after surgery. After treatment with nivolumab, this patient’s symptoms improved, the brain damage resolved, and reactions occurred at other metastatic sites.…”

The EMT transcription factor, Twist1, as a novel therapeutic target for pulmonary sarcomatoid carcinomas

“…The clinical behaviour of PSCs is extremely aggressive, and patient prognosis is extremely poor (2,3), since these tumours have a high rate of distant metastasis. The effect of conventional chemotherapy for PSCs remains controversial due to their low incidence (4); thus, progress on tumour treatments is moderate.…”

Infarct-Like Spindle Cell Carcinoma of the Lung: Clinicopathologic, Immunohistochemical, and Molecular Analysis of 4 Cases

“…Several experiences have recently supported this view on clinical ground, evidencing extraordinary response to nivolumab. [20][21][22] For this, it is essential to be aware of sarcomatoid spindle cell carcinomas mimicking nonneoplastic conditions to ensure a correct diagnosis but also alternative effective treatments.…”