Pembrolizumab combined with anlotinib improves therapeutic efficacy in pulmonary sarcomatoid carcinoma with TMB-H and PD-L1 expression: a case report and literature review

Abstract

BackgroundPulmonary sarcomatoid carcinoma (PSC) is a unique subtype of non-small cell lung cancer (NSCLC) with a high degree of malignancy and poor therapeutic effects. With the widespread use of immune checkpoint inhibitors (ICIs) in recent years, few studies have reported that immunotherapy is effective against PSC. As a multi-target anti-vascular targeting agent, anlotinib showed a better anti-tumor effect in various cancer species. The paper reported the therapeutic and side effects of pembrolizumab combined with anlotinib in a patient with advanced PSC.Case presentationThis is a 73 year old female patient who underwent thoracoscopy right upper lobectomy and was diagnosed as locally advanced PSC. However, the patient experienced tumor recurrence and metastasis 7 weeks after surgery and was unable to tolerate chemoradiotherapy. Moreover, she detected TP53 mutation and found that tumor mutation burden (TMB) and PD-L1 were high expression. Therefore, the patient received pembrolizumab combined with anlotinib treatment. After 15 cycles of treatment, the tumor significantly shrank with no tumor activity. The evaluation of tumor efficacy is partial response (PR). During the treatment period, she experienced one-degree thyroid-stimulating hormone elevation and two-degree hand-foot syndrome. Pembrolizumab and anlotinib was continued for two years as a maintenance treatment. The patient had a good quality of life and no disease progression was observed. Currently, the patient is still alive without tumor progression and has overall survival exceeding 45 months and toxic side effects were tolerable.ConclusionsCombining ICIs and anti-angiogenic targeted therapy has brought new hope in treating advanced PSC. Additionally, TMB and PD-L1 expression could be potential predictive biomarkers of the efficacy in advanced PSC with immunotherapy.

Sintilimab combined with anlotinib as first-line treatment for advanced sarcomatoid carcinoma of head and neck: a case report and literature review

“…Doomblides, C et al showed a report on LSC that patients with high TMB had a median OS of 18 months, while the low TMB population had only 1.84 months (49). Other case reports of sarcomatoid carcinoma have also shown a longer survival time with a higher TMB (32,43,37,38).The median value of TMB in patients with sarcomatoid carcinoma of the head and neck was 4.34 (0.71-14.71) muts/Mb, and TMB was significantly higher in patients with advanced stages compared to those with early stages (20). However, the relationship between TMB and immunotherapy in patients with sarcomatoid carcinoma of the head and neck has not been confirmed.…”

Case report: Pulmonary sarcomatoid carcinoma demonstrating rapid growth on follow-up CT

“…This case supports that timely surgery might lead to a good prognosis in PSC. Although there was not much evidence, the patient was given targeted therapy according to the gene result ( 14 , 16 , 26 ). Over-expression of PD-L1 is observed in more than half of pulmonary sarcomas, and the PD-1 inhibitor is gradually becoming a promising new method for the treatment of PSC patients ( 26 , 27 ).…”

“…Although there was not much evidence, the patient was given targeted therapy according to the gene result ( 14 , 16 , 26 ). Over-expression of PD-L1 is observed in more than half of pulmonary sarcomas, and the PD-1 inhibitor is gradually becoming a promising new method for the treatment of PSC patients ( 26 , 27 ). A multidisciplinary comprehensive approach, integrating clinical staging, pathology, genetic testing, and other disciplines, may help in selecting more appropriate and precise treatments, and might be an important direction for improving patient prognosis ( 26 , 28 ).…”

Biological characteristics and clinical treatment of pulmonary sarcomatoid carcinoma: a narrative review

“…A chemoresistant patient achieved CR over 20 months after treatment with tislelizumab plus anlotinib ( 109 ). Similarly, good efficacy was observed in cases treated with anlotinib combined with nivolumab ( 155 ), camrelizumab ( 156 ), or pembrolizumab ( 157 ).…”