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Complete response to sotorasib as neoadjuvant treatment in patient with locally advanced primary pulmonary sarcoma
Ce Li1, Yanan Wang2, Yongyang Yu1
1Department of Thoracic Surgery, Affiliated Hospital of Hebei University, Baoding, China.
Background:
Primary pulmonary sarcoma (PPS) is very rare relative to other subtypes of lung cancer. Therefore, evidence-based treatment options for PPS patients have remained unclear. Identification of actionable cancer driver mutations in patients with non-small cell lung cancer (NSCLC) has provided the chance to use targeted treatments and improve patient clinical outcomes. In addition to epidermal growth factor receptor (EGFR), the wide use of high-throughput genomic profiling with next-generation sequencing (NGS) has also identified other cancer driver genes such as Kirsten rat sarcoma (KRAS), human epidermal growth factor receptor 2 (HER2), and mesenchymal epithelial transition (MET).
Case Description:
In our study, we reported a locally advanced PPS patient harboring KRAS G12C mutation. The clinical stage before neoadjuvant treatment was stage IIIB (c.T3N2M0). The direct KRAS G12C inhibitor sotorasib (AMG-510) was used as neoadjuvant treatment and the patient achieved complete response (CR). Then, the patient underwent video-assisted thoracoscopic surgery (VATS) with reserved spontaneous breathing for surgical resection. The pathological evaluation was indicative of pathological CR (pCR). Further follow-ups are required to evaluate the long-term clinical benefit of neoadjuvant treatment with sotorasib and surgical resection with VATS.
Conclusions:
To our knowledge, it was the first study to use sotorasib for a PPS patient harboring KRAS G12C mutation in a neoadjuvant setting. Further follow-ups are required to evaluate the long-term clinical benefit of neoadjuvant treatment with sotorasib and surgical resection with VATS.
Insights
This study reports the first use of sotorasib, a KRAS G12C inhibitor, as neoadjuvant therapy for primary pulmonary sarcoma. The patient achieved a complete response, highlighting a potential new treatment strategy for this rare cancer.
Area of Science:
- Oncology
- Genomics
- Thoracic Surgery
Background:
- Primary pulmonary sarcoma (PPS) is a rare lung cancer subtype with unclear treatment options.
- Targeted therapies, driven by genomic profiling like next-generation sequencing (NGS), have improved outcomes in non-small cell lung cancer (NSCLC).
- Actionable mutations in genes such as EGFR, KRAS, HER2, and MET are increasingly identified.
Observation:
- A patient with locally advanced primary pulmonary sarcoma (stage IIIB) was identified with a KRAS G12C mutation.
- The patient received neoadjuvant treatment with sotorasib, a direct KRAS G12C inhibitor.
- The patient achieved a complete response (CR) after neoadjuvant therapy.
Findings:
- Neoadjuvant sotorasib treatment led to a complete pathological response (pCR) in the primary pulmonary sarcoma patient.
- The patient subsequently underwent successful video-assisted thoracoscopic surgery (VATS) with reserved spontaneous breathing.
- This represents the first reported case of neoadjuvant sotorasib use in a primary pulmonary sarcoma patient with a KRAS G12C mutation.
Implications:
- Sotorasib demonstrates potential as a neoadjuvant treatment for primary pulmonary sarcoma harboring the KRAS G12C mutation.
- This approach may offer a novel therapeutic strategy for patients with this rare malignancy.
- Further follow-up is necessary to assess the long-term clinical benefits of this treatment paradigm.
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