INTRODUCTION
The non-small cell lung cancer (NSCLC) known as pulmonary sarcomatoid
carcinoma (PSC) is a rare disease that is characterized by the
development of sarcomatoid-like changes and poor differentiation of
heterotypic cells. PSC was frequently detected at a later stage,
exhibited high levels of aggression, and had a poor prognosis regardless
of stage1,2. As classified, PSC was categorized into 5
subtypes, including pleomorphic carcinoma, spindle cell carcinoma, giant
cell carcinoma, carcinosarcoma, and pulmonary
blastoma1. Epidemiologically, the incidence of PSC
ranges from approximately 0.1% to 0.4% in NSCLC3.
Surgical resection is currently the preferred treatment, but guidelines
for adjuvant chemotherapy haven’t yet been established, especially for
the advanced stage4. However, the benefit of adjuvant
chemotherapy in surgically treated PSC patients in this rare cancer
remains controversial. Additionally, immuno-targeted therapy may be
important in the management of PSC. In unresectable diseases, patients
can usually only receive first-line chemotherapy, but often these
patients have poor responses5. In fact, in recent
years, due to the clinical application of the comprehensive treatment,
the mortality rate of NSCLC has been significantly decreased, and the
survival rate has been greatly improved, which is closely related to the
clinical research progress of immunotherapy and/or targeted therapy.
This was due to the clinical-specific inhibitory effect of EGFR and ALK
inhibitors on the corresponding high-expressing gene tumor
patients1,6. Moreover, newly discovered
pharmacogenetic drivers, such as ROS1 , RET ,NTRK1-3 , BRAF , MET , TP53 , and ERBB2 ,
as well as the implementation of immunotherapy and early detection
technologies, may further improve the 5-year survival rate of NSCLC, not
only PSC1. In this case, we discuss our experience
with the diagnosis and therapy of a PSC case with overexpressedROS1 and PD-L1 using chemo-, antiangiogenetic-, and
immunochemical therapy, also link a literature review. Therefore, the
new understanding and experience may serve as a foundation for future
PSC diagnoses and therapies.