TY - JOUR
T1 - Pulmonary sarcomatoid carcinoma presenting both ALK rearrangement and PD-L1 high positivity
T2 - A case report on the therapeutic regimen
AU - D'Antonio, Federica
AU - De Sanctis, Rita
AU - Bolengo, Isabella
AU - Destro, Annarita
AU - Rahal, Daoud
AU - De Vincenzo, Fabio
AU - Santoro, Armando
PY - 2019/8
Y1 - 2019/8
N2 - RATIONALE: Pulmonary sarcomatoid carcinoma (PSC) represents <1% of all lung cancers and is characterized by a very poor prognosis. The optimal therapeutic regimen remains unclear. We describe a rare case of PSC with both anaplastic lymphoma kinase (ALK)-arranged and high levels of programmed death ligand 1 (PD-L1) expression.PATIENT CONCERNS: A 46-year-old woman, nonsmoker, came to our attention due to uncontrolled pain in the lower left limb.DIAGNOSIS: PSC with both ALK rearrangement and high levels of PD-L1 expression.INTERVENTIONS: The patient started first-line systemic treatment with pembrolizumab reporting stable disease; at progression, she received second-line treatment with crizotinib. The treatment was not well-tolerated, and the patient then underwent 5 cycles of ceritinib treatment.OUTCOMES: The patient showed a partial response to targeted therapy. At progression, brigatinib was initiated, but the patients reported liver progression soon after the initiation of this therapy.LESSONS: Molecular-driven investigation is necessary in PSC for treatment selection.
AB - RATIONALE: Pulmonary sarcomatoid carcinoma (PSC) represents <1% of all lung cancers and is characterized by a very poor prognosis. The optimal therapeutic regimen remains unclear. We describe a rare case of PSC with both anaplastic lymphoma kinase (ALK)-arranged and high levels of programmed death ligand 1 (PD-L1) expression.PATIENT CONCERNS: A 46-year-old woman, nonsmoker, came to our attention due to uncontrolled pain in the lower left limb.DIAGNOSIS: PSC with both ALK rearrangement and high levels of PD-L1 expression.INTERVENTIONS: The patient started first-line systemic treatment with pembrolizumab reporting stable disease; at progression, she received second-line treatment with crizotinib. The treatment was not well-tolerated, and the patient then underwent 5 cycles of ceritinib treatment.OUTCOMES: The patient showed a partial response to targeted therapy. At progression, brigatinib was initiated, but the patients reported liver progression soon after the initiation of this therapy.LESSONS: Molecular-driven investigation is necessary in PSC for treatment selection.
KW - Anaplastic Lymphoma Kinase/metabolism
KW - Antineoplastic Agents/therapeutic use
KW - B7-H1 Antigen/metabolism
KW - Carcinosarcoma/drug therapy
KW - Female
KW - Humans
KW - Lung Neoplasms/drug therapy
KW - Middle Aged
U2 - 10.1097/MD.0000000000016754
DO - 10.1097/MD.0000000000016754
M3 - Article
C2 - 31393391
VL - 98
SP - e16754
JO - Medicine; analytical reviews of general medicine, neurology, psychiatry, dermatology, and pediatries
JF - Medicine; analytical reviews of general medicine, neurology, psychiatry, dermatology, and pediatries
SN - 0025-7974
IS - 32
ER -