A Remarkable Clinical Response to Pembrolizumab in a Rare Spindle Cell Carcinoma of the Lung.
A Remarkable Clinical Response to Pembrolizumab in a Rare Spindle Cell Carcinoma of the Lung.
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DOI：
10.31662/jmaj.2019-0015
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发表时间：
2020-01-15
期刊：
影响因子：
--
通讯作者：
Sugawara S
中科院分区：
文献类型：
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作者：
Tsurumi K;Kawashima Y;Akahira J;Saito R;Toi Y;Nakamura A;Yamanda S;Kimura Y;Honda Y;Sugawara S
肺梭形细胞癌仅由梭形肿瘤细胞组成，约占所有肉瘤样癌（SC）的13.3%，其是低分化非小细胞肺癌（NSCLC）的罕见亚型。肺梭形细胞癌由于对化疗和放疗耐药，预后极差。本病例报告描述了一名76岁男子，他表现出干咳和右侧颈部疼痛的症状，后来被诊断出患有肺梭形细胞癌。患者有2型糖尿病、心绞痛、房颤、高血压、高脂血症和B型肝炎病史，有20包年吸烟史。计算机断层扫描（CT）显示右上肺叶有一个厚壁空腔肿块。他的颈部疼痛与PET-CT图像一致，表明由于肺癌细胞浸润导致转移。肺活检组织中超过90%的肿瘤细胞表达PD-L1导致给予派姆单抗。9周后，肺和转移性肿瘤的大小显著减小，并且在11个疗程的派姆单抗给药中没有观察到肿瘤再生长。据我们所知，之前没有描述使用pembrolizumab治疗肺梭形细胞癌的报告。该病例报告表明，免疫疗法可能是罕见类型肺癌（包括梭形细胞癌）的一种有希望的治疗选择。
Spindle cell carcinoma of the lung consists of only spindle-shaped tumor cells, and accounts for approximately 13.3% of all sarcomatoid carcinomas (SCs), which are a rare subtype of poorly differentiated non-small cell lung cancer (NSCLC). Spindle cell carcinoma of the lung has very poor prognosis owing to resistance to chemotherapy and radiotherapy. This case report describes a 76-year-old man who presented with complaints of dry cough and right-sided neck pain and was later diagnosed with spindle cell carcinoma of the lung. He had a medical history of type 2 diabetes, angina pectoris, atrial fibrillation, hypertension, hyperlipidemia, and hepatitis B and a 20 pack-year history of smoking. A computed tomography (CT) scan revealed a mass with a thick-walled cavity in the right upper lobe of the lung. His neck pain was consistent with PET-CT images, indicating metastases due to invasion of lung cancer cells. The expression of PD-L1 in more than 90% of the tumor cells of the lung biopsy tissue led to the administration of pembrolizumab. The lung and metastatic tumors dramatically decreased in size after 9 weeks, and no tumor regrowth was observed over 11 courses of pembrolizumab administration. To the best of our knowledge, there are no previous reports describing the use of pembrolizumab for spindle cell carcinoma of the lung. This case report suggests that immunotherapy could be a promising treatment option for rare types of lung cancers, including spindle cell carcinoma.