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Case Report: A Rare Case of Metachronous Multiple Primary Lung Cancers in a Patient With Successful Management by Switching From Anti-PD-1 Therapy to Anti-PD-L1 Therapy

Without global standard diagnostic criteria, distinguishing multiple primary lung cancers (MPLCs) from intrapulmonary metastasis or histologic transformation has been a big challenge in clinical practice. Here, we described a rare case of metachronous adenocarcinoma and small cell lung cancer (SCLC)...

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Autores principales: Lin, Xinqing, Qiu, Guihuan, Li, Fang, Deng, Haiyi, Qin, Yinyin, Xie, Xiaohong, Jiang, Juhong, Song, Yong, Liu, Ming, Zhou, Chengzhi
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8207139/
https://www.ncbi.nlm.nih.gov/pubmed/34149722
http://dx.doi.org/10.3389/fimmu.2021.683202
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author Lin, Xinqing
Qiu, Guihuan
Li, Fang
Deng, Haiyi
Qin, Yinyin
Xie, Xiaohong
Jiang, Juhong
Song, Yong
Liu, Ming
Zhou, Chengzhi
author_facet Lin, Xinqing
Qiu, Guihuan
Li, Fang
Deng, Haiyi
Qin, Yinyin
Xie, Xiaohong
Jiang, Juhong
Song, Yong
Liu, Ming
Zhou, Chengzhi
author_sort Lin, Xinqing
collection PubMed
description Without global standard diagnostic criteria, distinguishing multiple primary lung cancers (MPLCs) from intrapulmonary metastasis or histologic transformation has been a big challenge in clinical practice. Here, we described a rare case of metachronous adenocarcinoma and small cell lung cancer (SCLC) in a patient who developed drug resistance to pembrolizumab. Both DNA-sequencing and RNA-sequencing were performed on primary adenocarcinoma and resistant lesions. Through the comparison of primary adenocarcinoma and novel lesion mutation profiles, along with bioinformatic estimation of immune proportion by using RNA sequence data, we revealed the origin and tumor microenvironment of the two lesions. No shared mutations were detected between lung adenocarcinoma (LUAD) and SCLC from the same patient, suggesting these two lesions might be from separate primary lung cancers. Compared to LUAD, SCLC showed a relatively cold microenvironment, including negative PD-L1. The patient obtained durable clinical benefits upon treatment with atezolizumab, without experiencing immune-related adverse events. Disease progression should be monitored with prompt re-biopsy and molecular profiling to spot a potential histologic change and to shed light on therapeutic alternatives. The use of atezolizumab, either alone or in combination with other agents, may be a potential therapeutic strategy for patients with both LUAD and SCLC.
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spelling pubmed-82071392021-06-17 Case Report: A Rare Case of Metachronous Multiple Primary Lung Cancers in a Patient With Successful Management by Switching From Anti-PD-1 Therapy to Anti-PD-L1 Therapy Lin, Xinqing Qiu, Guihuan Li, Fang Deng, Haiyi Qin, Yinyin Xie, Xiaohong Jiang, Juhong Song, Yong Liu, Ming Zhou, Chengzhi Front Immunol Immunology Without global standard diagnostic criteria, distinguishing multiple primary lung cancers (MPLCs) from intrapulmonary metastasis or histologic transformation has been a big challenge in clinical practice. Here, we described a rare case of metachronous adenocarcinoma and small cell lung cancer (SCLC) in a patient who developed drug resistance to pembrolizumab. Both DNA-sequencing and RNA-sequencing were performed on primary adenocarcinoma and resistant lesions. Through the comparison of primary adenocarcinoma and novel lesion mutation profiles, along with bioinformatic estimation of immune proportion by using RNA sequence data, we revealed the origin and tumor microenvironment of the two lesions. No shared mutations were detected between lung adenocarcinoma (LUAD) and SCLC from the same patient, suggesting these two lesions might be from separate primary lung cancers. Compared to LUAD, SCLC showed a relatively cold microenvironment, including negative PD-L1. The patient obtained durable clinical benefits upon treatment with atezolizumab, without experiencing immune-related adverse events. Disease progression should be monitored with prompt re-biopsy and molecular profiling to spot a potential histologic change and to shed light on therapeutic alternatives. The use of atezolizumab, either alone or in combination with other agents, may be a potential therapeutic strategy for patients with both LUAD and SCLC. Frontiers Media S.A. 2021-06-02 /pmc/articles/PMC8207139/ /pubmed/34149722 http://dx.doi.org/10.3389/fimmu.2021.683202 Text en Copyright © 2021 Lin, Qiu, Li, Deng, Qin, Xie, Jiang, Song, Liu and Zhou https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Immunology
Lin, Xinqing
Qiu, Guihuan
Li, Fang
Deng, Haiyi
Qin, Yinyin
Xie, Xiaohong
Jiang, Juhong
Song, Yong
Liu, Ming
Zhou, Chengzhi
Case Report: A Rare Case of Metachronous Multiple Primary Lung Cancers in a Patient With Successful Management by Switching From Anti-PD-1 Therapy to Anti-PD-L1 Therapy
title Case Report: A Rare Case of Metachronous Multiple Primary Lung Cancers in a Patient With Successful Management by Switching From Anti-PD-1 Therapy to Anti-PD-L1 Therapy
title_full Case Report: A Rare Case of Metachronous Multiple Primary Lung Cancers in a Patient With Successful Management by Switching From Anti-PD-1 Therapy to Anti-PD-L1 Therapy
title_fullStr Case Report: A Rare Case of Metachronous Multiple Primary Lung Cancers in a Patient With Successful Management by Switching From Anti-PD-1 Therapy to Anti-PD-L1 Therapy
title_full_unstemmed Case Report: A Rare Case of Metachronous Multiple Primary Lung Cancers in a Patient With Successful Management by Switching From Anti-PD-1 Therapy to Anti-PD-L1 Therapy
title_short Case Report: A Rare Case of Metachronous Multiple Primary Lung Cancers in a Patient With Successful Management by Switching From Anti-PD-1 Therapy to Anti-PD-L1 Therapy
title_sort case report: a rare case of metachronous multiple primary lung cancers in a patient with successful management by switching from anti-pd-1 therapy to anti-pd-l1 therapy
topic Immunology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8207139/
https://www.ncbi.nlm.nih.gov/pubmed/34149722
http://dx.doi.org/10.3389/fimmu.2021.683202
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