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Castelluccia A, Sardaro A, Niccoli Asabella A, Pisani AR, Rubini D, Portaluri M, Tramacere F. Durable complete response to PET-CT driven stereotactic radiation therapy plus pembrolizumab for pleomorphic Pancoast cancer: Case report and literature review. Clin Case Rep 2024; 12:e8633. [PMID: 38585585 PMCID: PMC10996042 DOI: 10.1002/ccr3.8633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 02/27/2024] [Accepted: 02/29/2024] [Indexed: 04/09/2024] Open
Abstract
PET-driven SBRT plus pembrolizumab as first-line therapy against pleomorphic Pancoast cancer appears beneficial, probably due to high equivalent doses of SBRT on photopenic necrotic core and synergic immune system stimulation of immunoradiotherapy.
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Affiliation(s)
| | - Angela Sardaro
- Section of Radiology and Radiation Oncology, Interdisciplinary Department of MedicineUniversity of Bari “Aldo Moro”BariItaly
| | - Artor Niccoli Asabella
- Section of Nuclear Medicine, Interdisciplinary Department of MedicineUniversity of Bari Aldo MoroBariItaly
| | - Antonio Rosario Pisani
- Section of Nuclear Medicine, Interdisciplinary Department of MedicineUniversity of Bari Aldo MoroBariItaly
| | - Dino Rubini
- Department of Precision MedicineUniversità degli Studi della Campania Luigi VanvitelliNapoliCampaniaItaly
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Kondo Y, Kunishige M, Kadota N, Okano Y, Machida H, Hatakeyama N, Naruse K, Shinohara T, Takeuchi E. A single dose of pembrolizumab treatment causing a profound and durable response in lung cancer. Thorac Cancer 2022; 13:648-652. [PMID: 35023292 PMCID: PMC8841699 DOI: 10.1111/1759-7714.14314] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 12/23/2021] [Accepted: 12/24/2021] [Indexed: 11/30/2022] Open
Abstract
Profound and durable responses to a single dose of pembrolizumab in lung cancer are rare. We encountered a non‐small cell lung cancer patient showing a deep and durable response with a single dose of pembrolizumab. A 79‐year‐old man reported bloody sputum for several weeks and visited a general physician. A chest x‐ray revealed a tumor shadow in the right middle lung field at that time, and the patient was referred to our hospital. He was diagnosed with adenocarcinoma of the lung by transbronchial biopsy. The expression of programmed death ligand 1 in tumor cells was 100% by immunostaining. Based on the above, immunotherapy with pembrolizumab was performed as first‐line therapy. Cancer cells had significantly shrunk at the end of the first cycle. The patient had grade‐3 immune‐related hepatitis at the end of the first cycle. Pembrolizumab treatment was stopped and prednisolone (80 mg/body) was initiated. Subsequently, liver function normalized, and prednisolone was tapered and discontinued. Since then, no tumor recurrence has been detected for 1.5 years without treatment. There have been few reports of profound and durable responses to a single dose of pembrolizumab in lung cancer. The results indicate that a single dose of pembrolizumab alone may be sufficient to cause durable response and serious immune‐related adverse events in some cases.
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Affiliation(s)
- Yoshihiro Kondo
- Department of Respiratory Medicine, National Hospital Organization Kochi Hospital, Kochi city, Kochi, Japan
| | - Michihiro Kunishige
- Department of Respiratory Medicine, National Hospital Organization Kochi Hospital, Kochi city, Kochi, Japan
| | - Naoki Kadota
- Department of Respiratory Medicine, National Hospital Organization Kochi Hospital, Kochi city, Kochi, Japan
| | - Yoshio Okano
- Department of Respiratory Medicine, National Hospital Organization Kochi Hospital, Kochi city, Kochi, Japan
| | - Hisanori Machida
- Department of Respiratory Medicine, National Hospital Organization Kochi Hospital, Kochi city, Kochi, Japan
| | - Nobuo Hatakeyama
- Department of Respiratory Medicine, National Hospital Organization Kochi Hospital, Kochi city, Kochi, Japan
| | - Keishi Naruse
- Department of Pathology, National Hospital Organization Kochi Hospital, Kochi city, Kochi, Japan
| | - Tsutomu Shinohara
- Department of Community Medicine for Respirology, Graduate School of Biomedical Sciences, Tokushima University, Kuramoto-cho, Tokushima, Japan
| | - Eiji Takeuchi
- Department of Clinical Investigation, National Hospital Organization Kochi Hospital, Kochi city, Kochi, Japan
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3
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Sako M, Nokihara H, Kondo K, Mitsuhashi A, Ozaki R, Yabuki Y, Abe A, Yoneda H, Ogino H, Otsuka K, Uehara H, Nishioka Y. A case of pulmonary pleomorphic carcinoma with preexisting interstitial pneumonia successfully treated with pembrolizumab. Thorac Cancer 2021; 13:129-132. [PMID: 34859591 PMCID: PMC8720630 DOI: 10.1111/1759-7714.14243] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 11/04/2021] [Accepted: 11/05/2021] [Indexed: 12/26/2022] Open
Abstract
Pulmonary pleomorphic carcinoma is often refractory to chemotherapy and follows an aggressive clinical course. Immune checkpoint inhibitors (ICIs) have revolutionized the treatment of advanced lung cancer, and a few cases with pleomorphic carcinoma have been reported to show tumor shrinkage after therapy with ICIs. When treating patients with ICIs, patient selection is essential, and monitoring and management of immune‐related adverse events, including pneumonitis, are needed. We herein report a case of pulmonary pleomorphic carcinoma with preexisting interstitial pneumonia treated with pembrolizumab, antiprogrammed cell death 1 antibody. Our report highlights important considerations necessary when treating advanced pleomorphic carcinoma patients complicated with interstitial pneumonia. We also review the literature regarding the use of ICIs in such patients.
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Affiliation(s)
- Masahiro Sako
- Department of Respiratory Medicine and Rheumatology, Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Japan.,Department of Community Medicine, Tokushima Prefectural Central Hospital, Tokushima, Japan
| | - Hiroshi Nokihara
- Department of Respiratory Medicine and Rheumatology, Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Japan
| | - Kensuke Kondo
- Department of Respiratory Medicine and Rheumatology, Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Japan.,Department of Community Medicine, Tokushima Prefectural Central Hospital, Tokushima, Japan
| | - Atsushi Mitsuhashi
- Department of Respiratory Medicine and Rheumatology, Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Japan
| | - Ryohiko Ozaki
- Department of Respiratory Medicine and Rheumatology, Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Japan
| | - Yohei Yabuki
- Department of Respiratory Medicine and Rheumatology, Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Japan
| | - Akane Abe
- Department of Respiratory Medicine and Rheumatology, Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Japan
| | - Hiroto Yoneda
- Department of Respiratory Medicine and Rheumatology, Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Japan
| | - Hirokazu Ogino
- Department of Respiratory Medicine and Rheumatology, Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Japan
| | - Kenji Otsuka
- Department of Respiratory Medicine and Rheumatology, Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Japan
| | - Hisanori Uehara
- Division of Pathology, Tokushima University Hospital, Tokushima, Japan
| | - Yasuhiko Nishioka
- Department of Respiratory Medicine and Rheumatology, Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Japan
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Ogawa D, Arahata M, Kuriyama M, Shinagawa S, Tomizawa G, Shimizu Y. Pulmonary Pleomorphic Carcinoma Mimicking Primary Sarcoma of the Neck: A Case Report and Literature Review. Clin Interv Aging 2021; 16:325-333. [PMID: 33654389 PMCID: PMC7914056 DOI: 10.2147/cia.s296875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 02/05/2021] [Indexed: 12/03/2022] Open
Abstract
We describe our challenge in diagnosing an unusual and rapidly progressing case of pulmonary pleomorphic carcinoma (PPC)—a rare, poorly differentiated, or undifferentiated non-small-cell carcinoma that can metastasize locally or distantly and has a poor prognosis. Our patient was an elderly man with a one-month history of abdominal pain, anorexia, and weight loss, diagnosed with atrophic gastritis via endoscopy, and treated medically without improvement. A week later, this patient developed pain in the head, neck, and shoulder area, and further examination revealed a thickening of his left neck and shoulder, with no palpable lymph nodes. Computed tomography (CT) of the neck, chest, and abdomen led us to believe that we might be dealing with primary sarcoma of the neck since no lung mass was evident. Further investigation could not be performed because the patient’s status deteriorated rapidly. An autopsy revealed that soft tissue in the left neck and the mesentery was invaded by poorly differentiated polymorphic malignant cells, which were also seen in the lung lesion. Immunohistochemically, these malignant cells were all positive for AE1/AE3, CAM5.2, TTF-1, Napsin-A, and Vimentin. The cells were also positive for programmed death-ligand 1 staining with a low level of tumor proportion score (over 1%). The final diagnosis was PPC with metastases to soft tissues in the left neck and the mesentery. A review of previous case reports of PPC revealed that soft tissue is an uncommon site for metastasis, and that our CT findings were rather unusual. We hereby present our case and review of published case reports, with the hope that an awareness of the heterogeneous features of PPC could prompt timely biopsy and histological diagnosis.
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Affiliation(s)
- Daishi Ogawa
- Nanto Community Medical Support Unit, Toyama University Hospital, Toyama, Toyama, Japan.,Department of General Medicine, Nanto Municipal Hospital, Toyama, Toyama, Japan
| | - Masahisa Arahata
- Department of General Medicine, Nanto Municipal Hospital, Toyama, Toyama, Japan
| | - Masato Kuriyama
- Department of Internal Medicine, Nanto Municipal Hospital, Nanto, Toyama, Japan
| | - Shunji Shinagawa
- Department of Internal Medicine, Nanto Municipal Hospital, Nanto, Toyama, Japan
| | - Gakuto Tomizawa
- Department of Radiology, Nanto Municipal Hospital, Nanto, Toyama, Japan
| | - Yukihiro Shimizu
- Department of Internal Medicine, Nanto Municipal Hospital, Nanto, Toyama, Japan
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Kong F, Wang W, Gong L, Wu W, Liu Y. Anti-PD-1 antibody camrelizumab plus doxorubicin showed durable response in pulmonary sarcomatoid carcinoma: Case report and literature review. J Clin Pharm Ther 2020; 45:1489-1496. [PMID: 32776600 DOI: 10.1111/jcpt.13234] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 06/26/2020] [Indexed: 01/07/2023]
Abstract
WHAT IS KNOWN AND OBJECTIVE Pulmonary sarcomatoid carcinoma (PSC) is characterized by dismal prognosis and resistance to platinum-based chemotherapy. The immune checkpoint inhibitors showed promising efficacy in the treatment of PSC. Camrelizumab is a programmed cell death protein 1 inhibitor; however, current evidence of its efficacy in PSC is lacking. CASE SUMMARY A 47-year-old female non-smoker presented with central-type masses in the right upper and lower lobes. PSC (cT4N2M0, stage IIIB) with positive expression of programmed death ligand-1 was diagnosed. First-line camrelizumab plus doxorubicin and cisplatin was introduced, followed by camrelizumab monotherapy due to grade 4 leukopenia and thrombocytopenia during the combination therapy. The lesions indicated a partial remission which endured for more than 20 months. WHAT IS NEW AND CONCLUSION Camrelizumab plus doxorubicin and cisplatin regimen is a promising option for PSC patients. Further high-quality trials are warranted.
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Affiliation(s)
- Fengwei Kong
- Department of General Surgery, Xuzhou Infectious Disease Hospital, Xuzhou, Jiangsu, People's Republic of China
| | - Weimin Wang
- Department of General Surgery, Xuzhou Infectious Disease Hospital, Xuzhou, Jiangsu, People's Republic of China
| | - Longbo Gong
- Department of Respiratory and Critical Care Medicine, Xuzhou Central Hospital, Xuzhou, People's Republic of China
| | - Wenbin Wu
- Department of Respiratory and Critical Care Medicine, Xuzhou Central Hospital, Xuzhou, People's Republic of China
| | - Yuanyuan Liu
- Department of Respiratory and Critical Care Medicine, Xuzhou Central Hospital, Xuzhou, People's Republic of China
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Manabe S, Kasajima R, Murakami S, Miyagi Y, Yokose T, Kondo T, Saito H, Ito H, Kaneko T, Yamada K. Analysis of targeted somatic mutations in pleomorphic carcinoma of the lung using next-generation sequencing technique. Thorac Cancer 2020; 11:2262-2269. [PMID: 32578376 PMCID: PMC7396383 DOI: 10.1111/1759-7714.13536] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 05/25/2020] [Accepted: 05/26/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Pleomorphic carcinoma (PC) of the lung is a rare type of lung cancer with aggressive characteristics and a poor prognosis. Because it is rare, the molecular characteristics of PC remain unclear. METHODS A gene mutation analysis was performed using next-generation sequencing (NGS) in patients with PC of the lung who had undergone surgical resection. RESULTS A total of nine patients were enrolled in the study. All the patients were male and eight had a history of smoking. Eight tumors contained spindle cells and three contained giant cells. Mutations considered significant were found in eight of the nine patients: in TP53 in five patients, in MET in two patients, and in ALK, ERBB2, PIK3CA, APC, NF1, and CDKN2A in one patient each. No EGFR mutation was detected in our analysis. Co-mutations were detected in three patients: TP53 with MET and NF1, TP53 with ERBB2, and PIK3CA with CDKN2A. CONCLUSIONS TP53 mutations were detected most frequently in PC of the lung with NGS analysis. Different co-mutations were seen in several specimens. KEY POINTS Significant findings of the study This study demonstrates that mutations in the TP53 gene are frequently found and co-mutations are sometimes found in pleomorphic carcinoma of the lung using genomic profiling analysis. What this study adds Our results will help to analogize the genetic characteristics and potential target of molecular-targeted agents of pleomorphic carcinoma of the lung.
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Affiliation(s)
- Saki Manabe
- Department of Thoracic OncologyKanagawa Cancer CenterYokohamaJapan
| | - Rika Kasajima
- Molecular Pathology and Genetics DivisionKanagawa Cancer Center Research InstituteYokohamaJapan
| | - Shuji Murakami
- Department of Thoracic OncologyKanagawa Cancer CenterYokohamaJapan
| | - Yohei Miyagi
- Molecular Pathology and Genetics DivisionKanagawa Cancer Center Research InstituteYokohamaJapan
| | | | - Tetsuro Kondo
- Department of Thoracic OncologyKanagawa Cancer CenterYokohamaJapan
| | - Haruhiro Saito
- Department of Thoracic OncologyKanagawa Cancer CenterYokohamaJapan
| | - Hiroyuki Ito
- Department of Thoracic OncologyKanagawa Cancer CenterYokohamaJapan
| | - Takeshi Kaneko
- Department of PulmonologyYokohama City University Graduate School of MedicineYokohamaJapan
| | - Kouzo Yamada
- Department of Thoracic OncologyKanagawa Cancer CenterYokohamaJapan
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Cimpeanu E, Ahmed J, Zafar W, DeMarinis A, Bardarov SS, Salman S, Bloomfield D. Pembrolizumab - emerging treatment of pulmonary sarcomatoid carcinoma: A case report. World J Clin Cases 2020; 8:97-102. [PMID: 31970174 PMCID: PMC6962068 DOI: 10.12998/wjcc.v8.i1.97] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 11/05/2019] [Accepted: 11/14/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Few studies have addressed the efficacy of pembrolizumab in pulmonary sarcomatoid carcinoma (PSC), a rare, previously rapidly fatal subtype of non-small-cell lung cancer. CASE SUMMARY We report the case of a 69-year-old man presented with respiratory distress caused by a large left upper lung lobe mass diagnosed as PSC with programmed death-ligand 1 expressed on more than 50 percent of tumor cells. The patient was started on pembrolizumab and, after 5 cycles, there was a more than 80 percent decrease in the size of the tumor mass. Further decrease was seen at the end of 10 cycles. The patient has been tolerating pembrolizumab well, with no limiting side-effects. Fourteen months after first coming into the hospital, he remains asymptomatic. CONCLUSION Pembrolizumab appears as a viable emerging treatment for PSC.
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Affiliation(s)
- Emanuela Cimpeanu
- Department of Internal Medicine, Richmond University Medical Center, Staten Island, NY 10310, United States
| | - Jibran Ahmed
- Department of Hematology and Medical Oncology, Westchester Medical Center, Valhalla, NY 10595, United States
| | - Wahib Zafar
- Department of Hematology and Medical Oncology, Westchester Medical Center, Valhalla, NY 10595, United States
| | - Adreana DeMarinis
- Department of Internal Medicine, Richmond University Medical Center, Staten Island, NY 10310, United States
| | - Svetoslav S Bardarov
- Department of Pathology, Richmond University Medical Center, Staten Island, NY 10310, United States
| | - Shamim Salman
- Department of Hematology and Medical Oncology, Richmond University Medical Center, Staten Island, NY 10310, United States
| | - Dennis Bloomfield
- Department of Internal Medicine, Richmond University Medical Center, Staten Island, NY 10310, United States
- Department of Clinical Research, Richmond University Medical Center, Staten Island, NY 10310, United States
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