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.