| Autor: |
Thomas V; Genomic Oncology Research Group, Department of Physiology and Medical Physics, RCSI University of Medicine and Health Sciences, D02 YN77 Dublin, Ireland.; Centre for Systems Medicine, RCSI University of Medicine and Health Sciences, D02 YN77 Dublin, Ireland., Rashed A; Our Lady of Lourdes Hospital, A92 VW28 Drogheda, Ireland.; Medical Oncology Group, Department of Molecular Medicine, RCSI University of Medicine and Health Sciences, D02 YN77 Dublin, Ireland., Faul C; St Luke's Radiation Oncology Network, D08 E797 Dublin, Ireland., Nicholson S; Department of Histopathology, St James's Hospital, D08 E797 Dublin, Ireland., Young V; Department of Cardiothoracic Surgery, St James's Hospital, D08 E797 Dublin, Ireland., Hanson J; Our Lady of Lourdes Hospital, A92 VW28 Drogheda, Ireland., Hennessy BT; Our Lady of Lourdes Hospital, A92 VW28 Drogheda, Ireland.; Medical Oncology Group, Department of Molecular Medicine, RCSI University of Medicine and Health Sciences, D02 YN77 Dublin, Ireland., Toomey S; Medical Oncology Group, Department of Molecular Medicine, RCSI University of Medicine and Health Sciences, D02 YN77 Dublin, Ireland., Furney SJ; Genomic Oncology Research Group, Department of Physiology and Medical Physics, RCSI University of Medicine and Health Sciences, D02 YN77 Dublin, Ireland.; Centre for Systems Medicine, RCSI University of Medicine and Health Sciences, D02 YN77 Dublin, Ireland. |
| Abstrakt: |
Up to 15% of lung cancer patients present two or more anatomically separate primary lung lesions, known as multiple primary lung cancers (MPLCs). While surgical resection or stereotactic body radiation therapy (SBRT) is the standard of care for most early-stage lung cancer cases, this may not be an option for patients with widespread tumours, highlighting the need for the improved targeted management of MPLC patients, which remains challenging. Moreover, the spontaneous regression (SR) of small-cell lung cancer (SCLC) is rare, with only four cases accounted for between 1988 and 2018. We report a rare MPLC case harbouring the mixed histology of non-small-cell lung cancer adenocarcinoma (NSCLCa) and SCLC and the SR of SCLC without treatment. The patient was diagnosed in 2015 with MPLCs, identified as NSCLCa and SCLC. In 2016, a restaging PET/CT scan prior to the start of treatment showed SCLC SR. In 2018, a further tumour was detected in the patient's mandible, and a re-biopsy of the SCLC revealed histology consistent with NSCLCa. Whole-genome sequencing (WGS) analysis identified a high expression of programmed death ligand-1 (PDL-1) in the NSCLCa, which was treated with pembrolizumab. WGS revealed distinct genomic profiles and mutational mechanisms in MPLCs, suggesting the need for distinct targeted therapies to improve the management of MPLC patients and highlighting the importance of precision evaluation. |
