Response of EGFR-mutated pulmonary pleomorphic carcinoma to pembrolizumab

Response of EGFR-mutated pulmonary pleomorphic carcinoma to pembrolizumab

Pulmonary pleomorphic carcinoma (PPC) is a rare and aggressive lung malignancy with limited treatment options. While immune checkpoint inhibitors (ICIs) have shown promise in treating PPC, evidence regarding their efficacy in epidermal growth factor receptor (EGFR)-mutated cases remains scarce. We r...

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Main Authors: Yuki Hatakeyama, Hidenori Mizugaki, Noriyuki Yamada, Yasushi Mizukami, Ken Kuwahara, Hajime Asahina, Hirofumi Adachi, Hiroshi Yokouchi, Yoshihiro Matsuno, Satoshi Oizumi
Format: Article
Language:English
Published: Elsevier 2025-01-01
Series:Respiratory Medicine Case Reports
Subjects:
Pleomorphic carcinoma
EGFR mutation
Pembrolizumab
Immunotherapy
PD-L1
Osimertinib
Online Access:http://www.sciencedirect.com/science/article/pii/S221300712500070X
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Summary:Pulmonary pleomorphic carcinoma (PPC) is a rare and aggressive lung malignancy with limited treatment options. While immune checkpoint inhibitors (ICIs) have shown promise in treating PPC, evidence regarding their efficacy in epidermal growth factor receptor (EGFR)-mutated cases remains scarce. We report a case of a woman in her 70s diagnosed with PPC harboring EGFR L858R + E709K mutations and high expression (95 %) of programmed death-ligand 1 (PD-L1). After relapsing from concurrent chemoradiotherapy for a Pancoast tumor, the patient received osimertinib as second-line therapy. Despite an initial response, rapid disease progression necessitated left lower lobectomy, confirming PPC diagnosis. Subsequent treatment with pembrolizumab achieved notably tumor response. Although Grade 3 immune-related colitis developed, it was successfully managed with prednisolone, allowing completion of six courses of pembrolizumab. This case demonstrates the potential efficacy of ICIs in EGFR-mutated PPC, even after epidermal growth factor receptor -tyrosine kinase inhibitor (EGFR-TKI) failure and highlights the importance of appropriate adverse event management. Our findings suggest that ICIs may be a viable treatment option for EGFR-mutated PPC patients, particularly those with high PD-L1 expression.
ISSN:2213-0071

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