Nivolumab-Induced Impressive Response of Refractory Pulmonary Sarcomatoid Carcinoma with Brain Metastasis

Background: Pulmonary sarcomatoid carcinoma is a rare, poorly differentiated, and highly aggressive type of non-small cell lung cancer. High tumor mutational burden and PD-L1 overexpression make it an excellent candidate for immunotherapy. Objectives and Method: We presented the case of a patient wh...

Full description

Saved in:
Bibliographic Details
Published inCase reports in oncology Vol. 11; no. 3; pp. 615 - 621
Main Authors Salati, Massimiliano, Baldessari, Cinzia, Calabrese, Fiorella, Rossi, Giulio, Pettorelli, Elisa, Grizzi, Giulia, Dominici, Massimo, Barbieri, Fausto
Format Journal Article
LanguageEnglish
Published Basel, Switzerland S. Karger AG 01.09.2018
Karger Publishers
Subjects
Abdomen
Brain cancer
Brain metastasis
Cancer therapies
Case Report
Case reports
Chemotherapy
Cloning
Family medical history
Histology
Immunotherapy
Lung cancer
Medical imaging
Melanoma
Metastasis
Monoclonal antibodies
Narcotics
Pneumonia
Pulmonary sarcomatoid carcinoma
Sarcoma
Targeted cancer therapy
Italy
Pulmonary sarcomatoid carcinoma
Immunotherapy
Lung cancer
Brain metastasis
Online AccessGet full text

Cover

More Information
Summary:Background: Pulmonary sarcomatoid carcinoma is a rare, poorly differentiated, and highly aggressive type of non-small cell lung cancer. High tumor mutational burden and PD-L1 overexpression make it an excellent candidate for immunotherapy. Objectives and Method: We presented the case of a patient who underwent left inferior lobectomy with concurrent right paravertebral muscular metastasectomy for an infiltrative neoplastic mass, whose final diagnosis was consistent with stage IV pulmonary sarcomatoid carcinoma. He received first- and second-line chemotherapy without any benefit. Since March 2016, he has been treated with the anti-PD1 agent nivolumab with a dramatic improvement of symptoms, disappearance of a brain lesion, and partial response on other metastatic sites. He tolerated the treatment well and is still responding after 22 months from the beginning. Results and Conclusions: In very lethal non-small cell lung cancer subtypes such as the sarcomatoid variants, high tumor burden and deteriorated general conditions should not preclude, at least in some cases, the use of immunotherapy. Anti-PD1 may also have a reliable role in disease control in the brain. Lastly, the strong rationale behind sarcomatoid histology should further prompt trials exploring immunotherapeutic approaches in this subset of non-small cell lung cancer.
Bibliography:Massimiliano Salati and Cinzia Baldessari contributed equally to this work.
ISSN:1662-6575
1662-6575
DOI:10.1159/000492666