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