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Next Generation Sequencing for the Detection of Actionable Mutations in Solid and Liquid Tumors
Published on: September 20, 2016
[Clinical analysis of lung adenocarcinoma with epidermal growth factor receptor mutation transformed into sarcoma]
1Department of Respiratory and Critical Care Medicine, First Affiliated Hospital of Soochow University, Suzhou 215006, China.
Abstract:
Objective: To analyze the clinical data of a case of lung adenocarcinoma with Epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs) resistance transforming into sarcoma, and to conduct a literature review to improve the understanding of the resistance mechanism. Histological transformation is a unique form of acquired resistance of EGFR-TKIs in non-small cell lung cancer (NSCLC). Thereinto, the transformation of small cell carcinoma is more common, and the transformation of sarcoma is rarely reported. Methods: Clinicopathological data on the treatment process, pathological features, and clinical outcome of the patient with EGFR-TKIs-resistance lung adenocarcinoma transforming into sarcoma were collected. The literature was reviewed to analyze the pathogenetic mechanism for sarcomatoid carcinoma or sarcoma transformation after drug resistance of adenocarcinoma, as well as the clinical characteristics of the patients and the corresponding therapeutic schemes. Results: We reported a patient with lung adenocarcinoma who developed EGFR-T790M mutation after first-line treatment with icotinib and sarcoma transformation after second-line treatment with almonertinib. Chemotherapy, radioactive particle implantation, antiangiogenic therapy and immunotherapy were followed, but the results were unsatisfactory. There was no report of EGFR-TKIs-resistant lung adenocarcinoma transforming into sarcoma. Among the 14 reports of adenocarcinoma transforming into sarcomatoid carcinoma, 8 cases had EGFR mutation, 3 cases had ALK mutation, 2 cases had ROS1 mutation, and 1 case had no asscoiated sensitive mutation. The median survival of 14 patients with adenocarcinoma transforming to sarcomatoid carcinoma was only 3 months. Conclusions: Sarcoma transformation can be one of the forms of drug resistance in patients with lung adenocarcinoma with EGFR-TKIs. The prognosis of patients with adenocarcinoma after transformation into sarcoma is poor.
Insights
Sarcoma transformation is a rare resistance mechanism in lung adenocarcinoma treated with EGFR-TKIs. This transformation leads to poor prognosis and limited treatment options for patients.
Area of Science:
- Oncology
- Molecular Biology
- Pathology
Background:
- Acquired resistance to Epidermal Growth Factor Receptor Tyrosine Kinase Inhibitors (EGFR-TKIs) is a significant challenge in non-small cell lung cancer (NSCLC).
- Histological transformation, particularly into small cell carcinoma, is a known resistance mechanism.
- Transformation into sarcoma is exceptionally rare, with limited understanding of its mechanisms and clinical implications.
Conclusions:
- Sarcoma transformation represents a rare but significant form of acquired resistance to EGFR-TKIs in lung adenocarcinoma.
- The prognosis for patients with lung adenocarcinoma that transforms into sarcoma is extremely poor.
- Further research is needed to understand the mechanisms and develop effective therapeutic strategies for this rare transformation.
