Case Report: Pulmonary Metastases From Epithelioid Sarcoma in Extremity Favourably Responding to Immunotherapy With Camrelizumab

SMARCB1/INI-1-Deficient sinonasal carcinoma demonstrates a poor prognosis but favorable clinical outcomes after PD-1/PD-L1 inhibitor therapy: A case series

Despite advances in multimodal cancer therapy, such as combining radical surgery with high-intensity chemoradiotherapy, for SMARCB1/INI-1-deficient sinonasal carcinoma (SDSC), the prognosis of patients remains poor. Immunotherapy is gaining increasing popularity as a novel treatment strategy for patients with SMARCB1/INI-1-deficient tumors. Herein, we report on the management of three patients with SDSC who received PD-1/PD-L1 inhibitor therapy as a part of multimodal therapy based on surgery and chemoradiotherapy. All three patients survived and demonstrated good clinical remission and disease control. To our knowledge, this is the first case series reporting the use of immunotherapy to improve clinical outcomes in neoadjuvant, adjuvant, and late first-line stages of treatment in patients with SDSC. Furthermore, we reviewed the relevant literature and further explored the correlation between SMARCB1/INI-1 deletion and immunotherapy.

SMARCA4-deficient epithelioid sarcoma revealed by comprehensive genomic profiling, leading to a notable response by nivolumab treatment

A 50-year-old man presented with a bulky mass in the left thigh and was referred to our department. He showed an impaired Eastern Cooperative Oncology Group performance status of 3 due to swelling of the left thigh and pain. Imaging analysis revealed a large mass measuring 16 cm in the left thigh and right forearm, along with the bilateral adrenal gland, right lung, right axillary lymph nodes, liver, and left femur. Despite additional tests, including pathological examination, the primary origin of the tumors could not be identified. Because of the rapid tumor progression, he was placed on nivolumab (NIVO; 240 mg/body, every 2 weeks) monotherapy based on the diagnosis of cancer of unknown primary, unfavorable type. Simultaneous comprehensive genomic profiling (CGP) test revealed a high tumor mutation burden (15.69 Muts/Mb) and a truncating mutation of SMARCA4, along with loss of BRG1 expression detected by additional immunohistochemical (IHC) analysis. Based on the predominance of soft tissue in the lesion, histological and IHC findings, and genomic phenotype, the patient was finally re-diagnosed with SMARCA4-deficient, SMARCB1/INI-1-preserved epithelioid sarcoma (ES). He showed a dramatic improvement in physical and laboratory findings at 5 weeks after the initial NIVO dose. Although he experienced immune-related adverse events, such as liver dysfunction, colitis and relative adrenal failure, and severe sepsis due to pulmonary cyst infection, he was able to overcome these complications. By the 12th dose of NIVO (13 months after the initial treatment), he has exhibited a positive response to NIVO without any additional complications. Among SMARCA4-deficient tumors, there have been multiple reports on the sensitivity of SMARCA4-deficient thoracic tumors to immune checkpoint inhibitors (ICIs), including PD-1 blockade agents. This case indicates that SMARCA4-deficient SMARCB1/INI-1-preserved ES may share molecular pathological characteristics with SMARCA4-deficient thoracic tumors, given their similar sensitivity to ICIs. In addition, CGP may play an important role in hypothesizing the primary site of tumors and guiding treatment selection for rare cancers, as in the present case, which lacks established treatment options. Further data accumulation is essential to validate this approach.

Translational Aspects of Epithelioid Sarcoma: Current Consensus

Epithelioid sarcoma (EpS) is an ultra-rare malignant soft-tissue cancer mostly affecting adolescents and young adults. EpS often exhibits an unfavorable clinical course with fatal outcome in ∼50% of cases despite aggressive multimodal therapies combining surgery, chemotherapy, and irradiation. EpS is traditionally classified in a more common, less aggressive distal (classic) type and a rarer aggressive proximal type. Both subtypes are characterized by a loss of nuclear INI1 expression, most often following homozygous deletion of its encoding gene, SMARCB1-a core subunit of the SWI/SNF chromatin remodeling complex. In 2020, the EZH2 inhibitor tazemetostat was the first targeted therapy approved for EpS, raising new hopes. Still, the vast majority of patients did not benefit from this drug or relapsed rapidly. Further, other recent therapeutic modalities, including immunotherapy, are only effective in a fraction of patients. Thus, novel strategies, specifically targeted to EpS, are urgently needed. To accelerate translational research on EpS and eventually boost the discovery and development of new diagnostic tools and therapeutic options, a vibrant translational research community has formed in past years and held two international EpS digital expert meetings in 2021 and 2023. This review summarizes our current understanding of EpS from the translational research perspective and points to innovative research directions to address the most pressing questions in the field, as defined by expert consensus and patient advocacy groups.

CD3+ and CD8+ T-Cell-Based Immune Cell Score and PD-(L)1 Expression in Pulmonary Metastases of Microsatellite Stable Colorectal Cancer

The objective of this study was to evaluate the prognostic value of CD3⁺ and CD8⁺ based immune cell score (ICS), programmed death -1 (PD-1) and programmed death ligand -1 (PD-L1) in pulmonary metastases of proficient mismatch repair colorectal cancer (CRC) patients. A total of 101 pulmonary metastases and 62 primary CRC tumours were stained for CD3⁺, CD8⁺, PD-1 and PD-L1 expression. The prognostic value of ICS, PD-1/PD-L1 expression in 67 first pulmonary metastases and 61 primary CRC tumour was analysed. Comparative analysis was also performed between primary tumours and pulmonary metastases, as well as between T-cell densities and PD-1/PD-L1 expression. The 5-year overall survival rates of low, intermediate, and high ICS in pulmonary metastases were 10.0%, 25.5% and 47.0% (p = 0.046), respectively. Patients with high vs. low ICS in pulmonary metastases had a significantly better 5-year survival (adjusted HR 0.25, 95% CI 0.09-0.75, p = 0.013). High tumour cell PD-L1 expression in the pulmonary metastases was associated with improved survival (p = 0.024). Primary tumour CD8⁺ expression was significantly correlated with all T-cell densities in pulmonary metastases. Conclusion: The ICS evaluated from the resected pulmonary metastases of CRC showed significant prognostic value. High PD-L1 expression in pulmonary metastases is associated with favourable prognosis.