Anlotinib Combined With Chemotherapy for Recurrence of Pulmonary Sarcomatoid Cancer Previously Surgically Treated: A Case Report and Literature Review

Abstract

BackgroundPulmonary sarcomatoid cancer (PSC) is a very rare subtype of poorly differentiated non-small-lung-cancer (NSCLC) with very poor prognosis. To date, the optimal treatment for PSC has not been elucidated, and the efficacy of anlotinib in PSC has not been previously reported.Case PresentationA 77-year-old male patient was admitted with cough, expectoration, and blood-stained sputum for one month. CT showed a soft mass in the inferior lobe of the right lung, which was diagnosed as spindle cell carcinoma (PSC) by histopathology. A videothoracoscopic right lower lobectomy and mediastinal lymph node dissection procedure was performed on the patient, but the disease recurred one month after surgery. The patient was then given first-line chemotherapy with gemcitabine and albumin paclitaxel for one cycle, but the disease continued to progress. The patient then received anlotinib combined with second-line chemotherapy (dacarbazine and cis-platinum) for six cycles, and the response reached complete remission (CR). Then the patient was given maintenance therapy with anlotinib alone, and the disease was still stable at the most recent reexamination. Progression-free survival (PFS) has lasted for more than two years, without any intolerable toxicity.ConclusionThis postoperative recurrent PSC patient achieved significant clinical benefits with anlotinib treatment. Our findings provide direct evidence of the efficacy of anlotinib in PSC. More studies are needed to confirm our observation.

Anlotinib combined with chemotherapy and immunotherapy for advanced pulmonary sarcomatoid cancer: a case report and literature review

“…No severe complications are associated with apatinib therapy ( 24 ). Patients with post-operative recurrent PSC treated with anlotinib combined with chemotherapy (dacarbazine and cisplatin) have also achieved CR ( 25 ). However, the effectiveness of targeted therapy with anlotinib is only based on limited case reports.…”

Multimodality Treatment of Pulmonary Sarcomatoid Carcinoma: A Review of Current State of Art

“…Anlotinib is a potent multityrosine kinase inhibitor that could suppress angiogenesis and inhibit the activation of VEGFR2, PDGFRβ, and FGFR1 as well as their common downstream ERK signaling; in the phase III study ALTER 0303, anlotinib significantly increased OS and PFS in patients with advanced NSCLC after at least two lines of treatment [63,64]. A case of anlotinib was reported by Li et al in a 77-year-old male PSC patient; after disease progression following first-line chemotherapy, he was prescribed anlotinib combined with second-line chemotherapy (dacarbazine and cis-platinum) for six cycles, and the response reached complete remission [65]. In addition, a PSC patient receiving anlotinib combined with nivolumab was reported to achieve partial remission 8 weeks after initial treatment [66].…”

Anlotinib for Pulmonary Sarcomatoid Carcinoma

“…Sarcomatoid carcinoma (SC), comprising 0.1%–0.4% of all pulmonary malignancies, is a rare malignancy with a combination of epithelial and sarcoma or sarcoma-like components. 1 Pulmonary SC (PSC) is a recognized category of highly aggressive and poorly differentiated non–small-cell lung carcinoma, with 5 different subtypes: pleomorphic, spindle, giant cell, carcinosarcoma, and pulmonary blastoma. 1 PSC is more prevalent in current or former male smokers.…”

“…1 Pulmonary SC (PSC) is a recognized category of highly aggressive and poorly differentiated non–small-cell lung carcinoma, with 5 different subtypes: pleomorphic, spindle, giant cell, carcinosarcoma, and pulmonary blastoma. 1 PSC is more prevalent in current or former male smokers. 2 PSC is likely to relapse after radical surgery and typically resistant to conventional chemotherapy and radiotherapy with a poor prognosis.…”

“…Patients 4 and 5 were reported by previous studies. 1,2 Clinical data were shown in Table 1. Patient 4 was diagnosed with PSC and underwent lung biopsy (Ib stage).…”