Pulmonary sarcomatoid carcinoma presenting both ALK rearrangement and PD-L1 high positivity: A case report on the therapeutic regimen

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Abstract

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.

Original languageEnglish
Pages (from-to)e16754
JournalMedicine
Volume98
Issue number32
DOIs
Publication statusPublished - Aug 2019

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Keywords

  • Anaplastic Lymphoma Kinase/metabolism
  • Antineoplastic Agents/therapeutic use
  • B7-H1 Antigen/metabolism
  • Carcinosarcoma/drug therapy
  • Female
  • Humans
  • Lung Neoplasms/drug therapy
  • Middle Aged

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