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Transformation of Lung Squamous Cell Carcinoma to Small Cell Lung Cancer After Immunotherapy Resistance: A Case
Diming Wang1, Wei Ye2, Dongmei Chen1
1Department of Oncology, Anhui Chest Hospital, Hefei, 230022, People's Republic of China.
Abstract:
The transformation of lung adenocarcinoma to small cell lung cancer (SCLC) following treatment with epidermal growth factor (EGFR) receptor tyrosine kinase inhibitors (TKIs) is a relatively common phenomenon. However, transformation of non-small cell lung cancer (NSCLC) to SCLC following treatment with immunotherapy is very rare. Here, we report a case of a 56-year-old patient diagnosed with driver gene mutation-negative lung squamous cell carcinoma (SCC). He received four cycles of immunotherapy with sugemalimab and chemotherapy with albumin paclitaxel in combination with carboplatin, and a partial response was achieved. Subsequently, the patient received 5 cycles of immunotherapy with sugemalimab. However, he developed rapid progression of mediastinal lymph nodes, and biopsy results showed transformation to SCLC. His tumor did not respond to the next line of carboplatin combined with etoposide, and he died six months after the discovery of SCLC transformation. In conclusion, SCLC transformation is also an important resistance mechanism for lung SCC patients treated with immunotherapy and predicts a very poor outcome. Repeat biopsy is needed for advanced lung SCC that has progressed with immunotherapy.
Insights
Small cell lung cancer (SCLC) transformation is a rare but serious complication of immunotherapy for lung squamous cell carcinoma (SCC). This resistance mechanism predicts a poor outcome, necessitating repeat biopsies for advanced cases.
Area of Science:
- Oncology
- Immunotherapy
- Lung Cancer Research
Background:
- Transformation to small cell lung cancer (SCLC) is common after EGFR-TKI treatment for lung adenocarcinoma.
- Transformation to SCLC following immunotherapy for non-small cell lung cancer (NSCLC) is exceptionally rare.
Observation:
- A 56-year-old patient with driver gene-negative lung squamous cell carcinoma (SCC) achieved partial response to sugemalimab, albumin paclitaxel, and carboplatin.
- Following further sugemalimab treatment, the patient experienced rapid mediastinal lymph node progression, confirmed as SCLC transformation via biopsy.
Findings:
- The transformed SCLC was refractory to carboplatin and etoposide chemotherapy.
- The patient died six months after SCLC transformation was diagnosed, highlighting a poor prognosis.
Implications:
- Small cell lung cancer transformation represents a significant resistance mechanism in lung SCC patients undergoing immunotherapy.
- Repeat biopsies are crucial for advanced lung SCC progressing under immunotherapy to identify SCLC transformation.
- This phenomenon underscores the need for vigilant monitoring and potential treatment strategy adjustments in lung cancer immunotherapy.
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