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Small cell transformation of non‐small cell lung cancer under immunotherapy: Case series and literature review
In advanced lung cancer treatment, immunotherapy provides durable responses in some patients. However, other patients experience progressive disease and the resistance mechanisms to immunotherapy have yet been fully elucidated. Small cell transformation of non‐small cell lung cancer (NSCLC) is commo...
Autores principales: | , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
John Wiley & Sons Australia, Ltd
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8590890/ https://www.ncbi.nlm.nih.gov/pubmed/34622569 http://dx.doi.org/10.1111/1759-7714.14180 |
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author | Imakita, Takuma Fujita, Kohei Kanai, Osamu Okamura, Misato Hashimoto, Masayuki Nakatani, Koichi Sawai, Satoru Mio, Tadashi |
author_facet | Imakita, Takuma Fujita, Kohei Kanai, Osamu Okamura, Misato Hashimoto, Masayuki Nakatani, Koichi Sawai, Satoru Mio, Tadashi |
author_sort | Imakita, Takuma |
collection | PubMed |
description | In advanced lung cancer treatment, immunotherapy provides durable responses in some patients. However, other patients experience progressive disease and the resistance mechanisms to immunotherapy have yet been fully elucidated. Small cell transformation of non‐small cell lung cancer (NSCLC) is commonly recognized as one of the resistance mechanisms to epidermal growth factor receptor (EGFR)‐tyrosine kinase inhibitors in EGFR‐mutant NSCLC treatment. As a resistant mechanism for immunotherapy, we report the first case of small cell transformation in 2017. Since then, eight similar cases have been reported and the concept of small cell transformation is now becoming more prevalent as a mechanism of immunotherapy resistance. In our facility, we have experienced four cases of small cell transformation after immunotherapy (including the reported case in 2017). The histology of each primary tumor was squamous cell carcinoma, large cell type neuroendocrine carcinoma, or poorly differentiated NSCLC. None had driver gene mutations. Nivolumab was administered in all four cases and atezolizumab was administered as a next line to nivolumab treatment in one case. The best response to immunotherapy was partial response or stable disease. There was a wide range of periods from the start of immunotherapy to confirmation of small cell transformation (from 2 weeks to almost 3 years). In conclusion, small cell transformation is an important resistance mechanism in cancer immunotherapy. When NSCLC progresses after immunotherapy, the possibility of small cell transformation and rebiopsy should always be encouraged, as it leads to clarification of the resistance mechanisms and frequency. |
format | Online Article Text |
id | pubmed-8590890 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | John Wiley & Sons Australia, Ltd |
record_format | MEDLINE/PubMed |
spelling | pubmed-85908902021-11-22 Small cell transformation of non‐small cell lung cancer under immunotherapy: Case series and literature review Imakita, Takuma Fujita, Kohei Kanai, Osamu Okamura, Misato Hashimoto, Masayuki Nakatani, Koichi Sawai, Satoru Mio, Tadashi Thorac Cancer Brief Report In advanced lung cancer treatment, immunotherapy provides durable responses in some patients. However, other patients experience progressive disease and the resistance mechanisms to immunotherapy have yet been fully elucidated. Small cell transformation of non‐small cell lung cancer (NSCLC) is commonly recognized as one of the resistance mechanisms to epidermal growth factor receptor (EGFR)‐tyrosine kinase inhibitors in EGFR‐mutant NSCLC treatment. As a resistant mechanism for immunotherapy, we report the first case of small cell transformation in 2017. Since then, eight similar cases have been reported and the concept of small cell transformation is now becoming more prevalent as a mechanism of immunotherapy resistance. In our facility, we have experienced four cases of small cell transformation after immunotherapy (including the reported case in 2017). The histology of each primary tumor was squamous cell carcinoma, large cell type neuroendocrine carcinoma, or poorly differentiated NSCLC. None had driver gene mutations. Nivolumab was administered in all four cases and atezolizumab was administered as a next line to nivolumab treatment in one case. The best response to immunotherapy was partial response or stable disease. There was a wide range of periods from the start of immunotherapy to confirmation of small cell transformation (from 2 weeks to almost 3 years). In conclusion, small cell transformation is an important resistance mechanism in cancer immunotherapy. When NSCLC progresses after immunotherapy, the possibility of small cell transformation and rebiopsy should always be encouraged, as it leads to clarification of the resistance mechanisms and frequency. John Wiley & Sons Australia, Ltd 2021-10-07 2021-11 /pmc/articles/PMC8590890/ /pubmed/34622569 http://dx.doi.org/10.1111/1759-7714.14180 Text en © 2021 The Authors. Thoracic Cancer published by China Lung Oncology Group and John Wiley & Sons Australia, Ltd. https://creativecommons.org/licenses/by/4.0/This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Brief Report Imakita, Takuma Fujita, Kohei Kanai, Osamu Okamura, Misato Hashimoto, Masayuki Nakatani, Koichi Sawai, Satoru Mio, Tadashi Small cell transformation of non‐small cell lung cancer under immunotherapy: Case series and literature review |
title | Small cell transformation of non‐small cell lung cancer under immunotherapy: Case series and literature review |
title_full | Small cell transformation of non‐small cell lung cancer under immunotherapy: Case series and literature review |
title_fullStr | Small cell transformation of non‐small cell lung cancer under immunotherapy: Case series and literature review |
title_full_unstemmed | Small cell transformation of non‐small cell lung cancer under immunotherapy: Case series and literature review |
title_short | Small cell transformation of non‐small cell lung cancer under immunotherapy: Case series and literature review |
title_sort | small cell transformation of non‐small cell lung cancer under immunotherapy: case series and literature review |
topic | Brief Report |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8590890/ https://www.ncbi.nlm.nih.gov/pubmed/34622569 http://dx.doi.org/10.1111/1759-7714.14180 |
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