YO16 - NSCLC contained sarcomatoid components with an impressive response to nivolumab therapy: a report of two cases.

Date 18 December 2016
Event ESMO Asia 2016 Congress
Session Poster lunch
Topics Non-Small-Cell Lung Cancer, Metastatic
Presenter Takahiro Ota
Authors T. Ota, K. Kirita, H. Udagawa, S. Umemura, S. Matsumoto, K. Yoh, S. Niho, K. Goto
  • Thoracic Oncology, National Cancer Center Hospital East, 277-8577 - Kashiwa/JP


Case Summary

Pulmonary pleomorphic carcinoma (PPCs) is a rare type of poorly differentiated non-small cell lung cancer that is part of sarcomatoid carcinoma. It shows a bad prognosis and resistance to chemotherapy and radiotherapy. Although previous studies have been reported that PPCs very frequently express PD-L1 and its expression in PPCs was significantly higher in sarcomatous area than in the carcinomatous portion, it has been unknown for NSCLC contained sarcomatoid components to response immune checkpoint inhibitor yet. Here we describe 2 patients with advanced NSCLC; one case had favor adenocarcinoma contained sarcomatoid components and another case had PPCs which was resistant to platinum-based chemotherapy, but dramatically responded to nivolumab.

In one case, a 50-year-old man presented with a solitary 3.7-cm mass in the right lower lobe and submucosal tumor in the colon. EBUS-TBNA and colon biopsy yielded the diagnosis of adenocarcinoma with sarcomatoid features and metastatic colon cancer. The patient was treated with cisplatin plus pemetrexed. But his disease proved resistant and remarked increasing in bilateral adrenal gland metastases with poor performance status (PS). Nivolumab was administered as a second-line treatment. He showed partial response following four cycles and dramatic improvement of PS. In another case, a 57-year-old man presented with a solitary 3.5-cm mass in the left lower lobe. He underwent left lower lobectomy, and histological diagnosis was obtained as stage IIIA PPCs (pT2bN2M0). The tumor relapsed in pleura, lung, bone, stomach, and intestine two months later and he was treated with one cycle of carboplatin plus paclitaxel, but the metastatic lesions progressed. Nivolumab was administered as a second-line treatment. Chest X-ray revealed impressive reduction of pulmonary and pleural lesions 7 days after the start of nivolumab therapy. Those two patients continue to receive nivolumab therapy without any sign of aggravation. These two cases suggest that nivolumab is a potent therapeutic option for NSCLC contained sarcomatoid composition.