Case Report
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jul 6, 2020; 8(13): 2876-2884
Published online Jul 6, 2020. doi: 10.12998/wjcc.v8.i13.2876
Significant benefits of pembrolizumab in treating refractory advanced pulmonary sarcomatoid carcinoma: A case report
Ping Chen, Min Yu, Ji-Liang Zhang, Wei-Yong Chen, Li Zhu, Yue Song, Cheng-Yi Jiang, Shuang Zhang
Ping Chen, Ji-Liang Zhang, Wei-Yong Chen, Li Zhu, Yue Song, Cheng-Yi Jiang, Department of Oncology, Chengdu Seventh People’s Hospital, Chengdu Tumor Hospital, Chengdu 610041, Sichuan Province, China
Min Yu, Department of Thoracic Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
Shuang Zhang, Department of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
Author contributions: Chen P, Yu M, and Zhuang S reviewed the literature and contributed to manuscript drafting; Zhang JL and Chen WY contributed to manuscript drafting; Zhu L and Song Y analyzed and interpreted the imaging findings; Chen P, Yu M, Zhuang S, and Jiang CY were responsible for revising the manuscript for important intellectual content; all authors provided final approval for the version to be submitted; Chen P and Yu M contributed equally to this work.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Shuang Zhang, MD, PhD, Doctor, Department of Biotherapy, Cancer Center, West China Hospital, Sichuan University, No. 37, Guoxue Xiang, Chengdu 610041, Sichuan Province, China. shuangscu@126.com
Received: January 26, 2020
Peer-review started: January 26, 2020
First decision: February 26, 2020
Revised: March 26, 2020
Accepted: June 7, 2020
Article in press: June 7, 2020
Published online: July 6, 2020
Abstract
BACKGROUND

Pulmonary sarcomatoid carcinoma (PSC), a rare subtype of non-small cell lung cancer (NSCLC), is poorly differentiated and highly aggressive. Treatment is limited, and the prognosis is poor. Pembrolizumab is an anti-programmed death (PD)-1 antibody with good efficacy in NSCLC. Recent studies have demonstrated that PD-ligand 1 (PD-L1) overexpression is common in PSCs, which suggests that anti-PD-L1 treatment is an ideal option. However, the response to pembrolizumab in PSC has not been studied.

CASE SUMMARY

We present a PSC case with PD-L1 overexpression that significantly benefited from pembrolizumab. A 73-year-old Chinese male was detected with a right lung lesion. Pathological analysis of the right upper lobectomy confirmed PSC. The PD-L1 test revealed overexpression (TPS: 90%). Multiple metastases occurred 1 mo after surgery, representing stage IV PSC. Neither first-line chemotherapy nor second-line antiangiogenic agents showed any benefit. Radiotherapy (1200 cGy) was administered to relieve chest wall pain. The patient received the PD-1 inhibitor pembrolizumab (100 mg) as third-line therapy; however, because of fever and severe infection, he refused to receive immunotherapy any longer. Thus, only one dose of pembrolizumab was administered. Deep sustained remission of most of the metastases was achieved except for lesions in the right adrenal gland, which first shrank and then progressed. The patient died because of disease progression in the right adrenal gland. He achieved a progression-free survival time of 8 mo and an overall survival time of 9 mo with third-line pembrolizumab.

CONCLUSION

Our findings highlight and offer direct evidence of the efficacy of pembrolizumab in PD-L1-overexpressing PSCs. Combined radiotherapy and immunotherapy may enhance treatment efficacy.

Keywords: Pulmonary sarcomatoid carcinoma, Immunotherapy, Programmed death-ligand 1, Pembrolizumab, Radiotherapy, Case report

Core tip: This is a report of a patient with programmed death-ligand 1 (known as PD-L1)-overexpressing pulmonary sarcomatoid carcinoma with a good response to pembrolizumab, indicating that pembrolizumab is an important treatment for pulmonary sarcomatoid carcinoma patients with PD-L1 overexpression. In this case, the patient received low-dose radiotherapy before pembrolizumab, which suggests that the combination of radiotherapy and immunotherapy may elevate treatment efficacy.