■肺肉瘤样癌(PSC)是非小细胞肺癌(NSCLC)的一种罕见亚型,对化疗和放疗耐药,预后较差。PSC是高度恶性的,即使在手术后也容易复发。程序性死亡配体1(PD-L1)肿瘤细胞比例评分(TPS)5%,在该患者中检测到TERT和TP53基因突变,并伴有多个转移部位。安洛替尼是一种新型的多靶点酪氨酸激酶抑制剂(TKI),可有效治疗晚期NSCLC和一些肉瘤患者。有限的临床试验和病例报告表明,具有基因突变和PD-L1表达的PSC患者对多靶点抗血管生成药物和免疫检查点抑制剂(ICIs)具有良好的反应。在这篇文章中,我们报道了一例转移性PSC病例,该病例通过计算机断层扫描(CT)引导下的穿刺活检术诊断为接受免疫治疗联合抗血管生成药物作为新辅助化疗(NACT)治疗.PSC得到控制,患者通过手术切除成功实现保肢治疗。因此,靶向治疗和免疫治疗可以为转移性PSC患者的保肢提供足够的手术机会。
■2022年6月,一名被诊断为股骨近端恶性骨肿瘤的69岁男性因反复发烧以及左大腿肿胀和疼痛20天而入院。胸部的初始计算机断层扫描(CT)扫描显示肺腔(20mm×30mm)和分散的肺部肿块。随后,他接受了CT引导下的穿刺活检,以区分左侧股骨近端溶骨性骨破坏和软组织肿块的实质,后者显示转移性肉瘤样癌的组织学。基因检测显示TERTc.-124C突变(丰度8.81%),TP53p.R342突变(丰度11.35%),肿瘤突变负荷(TMB)7.09muts/Mb,微卫星稳定性(MSS),PD-L1(SP263)TPS也检测到5%。患者暂时接受抗血管生成药物和PD-1抑制剂的组合治疗。经过一个疗程,联合治疗后,磁共振成像(MRI)肿瘤体积明显缩小,股骨发生病理性骨折。患者退热后接受了股骨近端肿瘤切除和假体置换。将sindilimab与安洛替尼顺序施用超过1年。最后,局部肿瘤控制良好,未观察到明显的药物相关不良反应。通过影像学检查观察到,肺部病变保持部分反应(PR)超过16个月,股骨近端转移性肿瘤完全反应(CR)。
■这是第一例报道的股骨转移性PSC病例,显示出对安洛替尼与辛替利玛联合治疗的良好反应。此病例表明,抗血管生成治疗联合免疫治疗可能会使转移性PSC患者在术前辅助治疗中受益。
UNASSIGNED: Pulmonary sarcomatoid carcinoma (PSC) is a rare subtype of non-small-cell lung cancer (NSCLC), which is resistant to chemotherapy and radiotherapy with a poor prognosis. PSC is highly malignant and is prone to recurrence even after surgery. The programmed death-ligand 1 (PD-L1) tumor cell proportion score (TPS) 5%, TERT and TP53 gene mutations were detected in this patient accompanied by multiple metastatic sites. The anlotinib is a novel multitarget tyrosine kinase inhibitor (TKI) that could be effective for advanced NSCLC and some sarcoma patients. Limited clinical trials and
case reports have shown that PSC patients with gene mutations and PD-L1 expression have good responses to multitarget antiangiogenic drug and immune checkpoint inhibitors (ICIs). In this article, we reported a
case with metastatic PSC diagnosed by Computed Tomography (CT)-guided needle biopsy treated with immunotherapy combined with antiangiogenic drugs as a neoadjuvant chemotherapy (NACT). PSC is controlled and the patient achieves successfully limb salvage treatment by surgical resection. Therefore, targeted therapy and immunotherapy can provide sufficient surgical opportunities for limb salvage in the treatment of metastatic PSC patients.
UNASSIGNED: A 69-year-old male diagnosed with malignant bone tumor in the proximal femur was admitted to our hospital in June 2022 with recurrent fever as well as swelling and pain in the left thigh for twenty days. The initial computed tomography (CT) scan of the chest showed a pulmonary cavity (20 mm × 30 mm) and scattered lung masses. Subsequently, he underwent a CT-guided needle biopsy to distinguish the essence of osteolytic bone destruction and soft tissue mass in the left proximal femur which showed metastatic sarcomatoid carcinoma histology. Genetic testing revealed TERT c.-124C mutation (abundance 8.81%), TP53 p.R342 mutation (abundance 11.35%), tumor mutational burden (TMB) 7.09 muts/Mb, microsatellite stability (MSS), and PD-L1 (SP263) TPS 5% were also detected. The patient was tentatively treated with a combination of antiangiogenic drug and PD-1 inhibitor. After one course, the tumor volume significantly reduced in magnetic resonance imaging (MRI) and pathological fracture occurred in the femur after combined treatment. The patient received proximal femoral tumor resection and prosthesis replacement after defervescence. Sequentially sintilimab with anlotinib were administered for over 1 year. Finally, the local tumor was well controlled, and no obvious drug-related adverse reactions were observed. The lesions in the lung remained in partial response (PR) for more than 16 months and complete response (CR) of metastatic tumor in the proximal femur was observed through imaging examinations.
UNASSIGNED: This is the first reported
case of a metastatic PSC in femur showing a favorable response to the treatment consisting of anlotinib combined with sintilimab. This
case suggests that antiangiogenic therapy combined with immunotherapy may benefit patients with metastatic PSC in the preoperative adjuvant therapy for limb salvage.