BACKGROUND: Primary cardiac angiosarcoma(PCA) has a low incidence rate and poor prognosis. Currently, no unified clinical treatment standards are available.
METHODS: We report the case of a 48-year-old man presenting chest tightness, breathlessness, and dyspnea. Imaging and postoperative histopathologic studies confirmed PCA and that the tumor had invaded the entire right atrium. The patient developed progressive disease (PD) during postoperative radiotherapy. We used immunotherapy combined with targeted therapy based on the results of molecular profile and evaluation of tertiary lymphoid structures (TLSs) and programmed cell death-ligand 1 (PD-L1). After treatment, the metastatic lymph nodes of the patient were reduced to a certain extent, indicating that combination therapy was effective.
CONCLUSIONS: To the best of our knowledge, this is the first report of radiotherapy combined with anti-PD-1 and tyrosine kinase inhibitors(TKI) for PCA. In addition, this is the first report on immunotherapy for PCA based on new evaluation methods, including TLSs, PD-L1, and genomic profile.

UNASSIGNED: Non-small cell lung cancer (NSCLC) is one of the most common malignancies in the world. Osimertinib is a third-generation epidermal growth factor receptor tyrosine kinase inhibitor (EGFR-TKI) indicated for NSCLC that effectively targets sensitive epidermal growth factor receptor mutation and exon20 T790M. Despite initially impressive outcomes, acquired resistance (AR) develops rapidly, typically within 9-13 months, and the mechanisms of resistance are not fully understood. Over the past years, EGFR-TKI and programmed cell death-ligand 1 (PD-L1) inhibitors have been widely used to treat for patients with advanced lung adenocarcinoma.
UNASSIGNED: Herein we report a middle-aged female who suffered from lung adenocarcinoma based on the pathological diagnosis. Epidermal growth factor receptor exon 19 deletion was detected by next-generation sequencing (NGS). After the patient underwent a series of treatments, including osimertinib, BTN2A1-BRAF fusion was identified. After assessing PD-L1 expression by immunohistochemistry (IHC), the patient was switched to duvalizumab, a PD-L1 inhibitor, but no significant improvements were observed. NGS and IHC assays were conducted to analyze the biopsy and blood samples obtained during treatment.
UNASSIGNED: This case substantiates that the acquisition of BTN2A1-BRAF fusion potentially serves as a mechanism of AR to osimertinib in NSCLC. Patients with sensitive epidermal growth factor receptor mutation derive minimal benefit from PD-L1 inhibitors irrespective of the degree of PD-L1 expression in the tumor tissue in IHC. Our case provides a new train of thought for treating this patient population.

The conventional etoposide-platinum (EP) regimen and adjuvant radiotherapy remain the gold-standard treatment for small cell lung cancer (SCLC). However, most patients already have multiple metastases when they are first diagnosed with SCLC. The objective response rate (ORR) and 1-year survival rate are low in these patients despite active radiotherapy and chemotherapy. SCLC is oncologically featured by the high tumor mutational burden (TMB) of multiple genes, which makes immunotherapy a possible new treatment strategy for SCLC. New data from the IMpower133 and CASPIAN trials will shed new light on the treatment of SCLC. In 2020, the results from the phase 3 CASPIAN trial have already suggested that programmed cell death-ligand 1 (PD-L1) inhibitors may represent breakthroughs in the management of SCLC. Here, we report a patient with extensive-stage SCLC (ES-SCLC) treated with first-line anti-PD-L1 immune checkpoint inhibitor (PD-L1 inhibitor) (i.e., durvalumab) combined with the EP regimen for 6 cycles. The patient consistently achieved partial response (PR) [nearly complete response (CR)], and no immune-related adverse events were noted during this period. The Karnofsky performance status (PS) score maintained at 1-2 points. We further review the history of SCLC treatment and elucidate the role of combination with immunotherapy in treating SCLC in the coming years.