Small Cell Lung Cancer Transformation as a Mechanism of Resistance to PD-1 Therapy in KRAS-Mutant Lung Adenocarcinoma: A Report of Two Cases Wade T.

Slides:

Advertisements

Similar presentations

Choroidal Metastases Responsive to Crizotinib Therapy in a Lung Adenocarcinoma Patient with ALK 2p23 Fusion Identified by ALK Immunohistochemistry Yan.

Advertisements

Acquired C797S Mutation upon Treatment with a T790M-Specific Third-Generation EGFR Inhibitor (HM61713) in Non–Small Cell Lung Cancer Haa-Na Song, MD,

A Case of a Patient with Idiopathic Pulmonary Fibrosis with Lung Squamous Cell Carcinoma Treated with Nivolumab Monica Khunger, MD Journal of Thoracic.

Kazuma Nagata, MD, Reiko Kaji, MD, Keisuke Tomii, MD

Jeffrey Bradley, MD Journal of Thoracic Oncology

Occam’s Razor and Hickam’s Dictum: A Rare Case of Synchronous Solid and Hematological Malignancies and Transformed EGFR-Mutated NSCLC Ciara Conduit,

Sequential Immunologic Reactions after Suspension of Nivolumab Treatment in Lung Adenocarcinoma Patient Hiromichi Shirasu, MD, Akira Ono, MD, Toshiaki.

Brain Radionecrosis Treated with Bevacizumab in a Patient with Resected Squamous Cell Carcinoma of the Lung Jordi Remon, MD, Cécile Le Péchoux, MD, Caroline.

Successful Osimertinib Rechallenge in a Patient with T790M-Mutant Non–Small Cell Lung Cancer after Osimertinib-Induced Interstitial Lung Disease Eisaku.

PET/CT Fusion Scan in Lung Cancer: Current Recommendations and Innovations Cristina Gámez, MD, PhD, Rafael Rosell, MD, PhD, Alejandro Fernández, MD, PhD,

Chia-Lin Hsu, MD, Kuan-Yu Chen, MD, PhD Journal of Thoracic Oncology

Longitudinal Cell-Free DNA Analysis in Patients with Small Cell Lung Cancer Reveals Dynamic Insights into Treatment Efficacy and Disease Relapse Karinna.

Two Cases of Small Cell Lung Cancer Transformation from EGFR Mutant Adenocarcinoma During AZD9291 Treatment Jun Soo Ham, MD, Seokhwi Kim, MD, Hee Kyung.

Resectable Clinical N2 Non–Small Cell Lung Cancer; What Is the Optimal Treatment Strategy? An Update by the British Thoracic Society Lung Cancer Specialist.

Abscopal Effect of Nivolumab in a Patient with Primary Lung Cancer

Response to Crizotinib/Erlotinib Combination in a Patient with a Primary EGFR-Mutant Adenocarcinoma and a Primary c-met–Amplified Adenocarcinoma of the.

Acquired C797S Mutation upon Treatment with a T790M-Specific Third-Generation EGFR Inhibitor (HM61713) in Non–Small Cell Lung Cancer Haa-Na Song, MD,

A Case of Concurrent De Novo C797S and L858R EGFR Mutation Detected in Stage IA Non–Small Cell Lung Cancer Patient Jong Sik Lee, MD, Jae Young Hur, PhD,

Radiotherapy Rescue of a Nivolumab-Refractory Immune Response in a Patient with PD-L1–Negative Metastatic Squamous Cell Carcinoma of the Lung Zhigang.

Response to Osimertinib in Choroidal Metastases from EGFRmt T790M–Positive Non– Small Cell Lung Adenocarcinoma Filippo Gustavo Dall’Olio, MD, Celeste.

Response to Crizotinib Rechallenge after Initial Progression and Intervening Chemotherapy in ALK Lung Cancer Eiko Theodora Browning, MD, Andrew James.

David T. Cooke, MD, Dennis J. Zheng, Karen A. Peterson, NP, Royce F

Afatinib-Induced Severe Interstitial Lung Disease Successfully Treated with High-Dose Corticosteroid Therapy: A Case Report Kazutaka Fujita, MD, Yuko.

Nivolumab Enhances the Inflammation of the Irradiation Field in Advanced Non–Small Cell Lung Cancer Hiromi Furuta, MD, PhD, Tatsuya Yoshida, MD, PhD,

Susan C. Scott, MD, Nathan A. Pennell, MD, PhD

A Case of a Patient with Idiopathic Pulmonary Fibrosis with Lung Squamous Cell Carcinoma Treated with Nivolumab Monica Khunger, MD Journal of Thoracic.

Rapidly Progressive Diffuse Cystic Lesions as a Radiological Hallmark of Lung Adenocarcinoma Jian Zhang, MD, Yi-Lin Zhao, MD, Ming-Xiang Ye, MD, Gang.

Rapid Response of Brain Metastasis to Crizotinib in a Patient with ALK Rearrangement– Positive Non–Small-Cell Lung Cancer Hiroyasu Kaneda, MD, PhD, Isamu.

Meghan Campo, MD, David Gerber, MD, Justin F. Gainor, MD, Rebecca S

Complete Response Achieved 1 Year after a Single Administration of Nivolumab in a Patient with Lung Adenocarcinoma with Negative Expression of PD-L1

Osimertinib Dose Escalation Induces Regression of Progressive EGFR T790M–Mutant Leptomeningeal Lung Adenocarcinoma Christine Cordova, MD, Andrew S. Chi,

Long-Lasting Response to Nivolumab and Immune-Related Adverse Events in a Nonsquamous Metastatic Non–Small Cell Lung Cancer Patient Biagio Ricciuti,

Successful Crizotinib Retreatment after Crizotinib-Induced Interstitial Lung Disease Satoru Yanagisawa, MD, PhD, Akira Inoue, MD, PhD, Akira Koarai, MD,

Coexistence of the BRAF Mutation and EGFR Exon 20 Insertion in a Patient with Lung Adenocarcinoma Lih-Chyun Chang, MD, Kuan-Yu Chen, MD, PhD, Jin-Yuan.

Circulating Tumor DNA Identifies EGFR Coamplification as a Mechanism of Resistance to Crizotinib in a Patient with Advanced MET-Amplified Lung Adenocarcinoma

Small Cell Transformation and T790M Mutation as Coresistance Mechanisms for First- line Epidermal Growth Factor Receptor (EGFR) Tyrosine Kinase Inhibitor.

Atypical Pleuropulmonary Tuberculosis Mimicking a Malignant Disease

Endobronchial Ultrasonography: Current Status and Future Directions

Histologic Transformation in NSCLC with PD-1 therapy

Effective Treatment with Icotinib in Primary Adenoid Cystic Carcinoma of the Lung with Liver Metastasis Zhengbo Song, MD, Wei Wu, MD, Yiping Zhang, MD

Ritbune Prakobkit, MD, William Churk-Nam Auyeung, MD

Strategies to Improve Outcomes of Patients with EGFR-Mutant Non–Small Cell Lung Cancer: Review of the Literature Caicun Zhou, MD, PhD, Luan Di Yao, MD

Transformation to SCLC after Treatment with the ALK Inhibitor Alectinib Shiro Fujita, MD, PhD, Katsuhiro Masago, MD, PhD, Nobuyuki Katakami, MD, PhD,

A Phase II Study of Paclitaxel + Etoposide + Cisplatin + Concurrent Radiation Therapy for Previously Untreated Limited Stage Small Cell Lung Cancer (E2596):

Are There Imaging Characteristics Associated with Epidermal Growth Factor Receptor and KRAS Mutations in Patients with Adenocarcinoma of the Lung with.

Choroidal Metastases Responsive to Crizotinib Therapy in a Lung Adenocarcinoma Patient with ALK 2p23 Fusion Identified by ALK Immunohistochemistry Yan.

A Different Method in Diagnosis of Multiple Primary Lung Cancer

Frequency of Lymph Node Metastasis According to the Size of Tumors in Resected Pulmonary Adenocarcinoma with a Size of 30 mm or Smaller Yangki Seok,

Mechanisms of Acquired Resistance to AZD9291

Bevacizumab Maintenance in Patients with Advanced Non–Small-Cell Lung Cancer, Clinical Patterns, and Outcomes in the Eastern Cooperative Oncology Group.

Nivolumab-Induced Acute Diabetes Mellitus and Hypophysitis in a Patient with Advanced Pulmonary Pleomorphic Carcinoma with a Prolonged Tumor Response

A Case of ALK-Rearranged Adenocarcinoma with Small Cell Carcinoma-Like Transformation and Resistance to Crizotinib Yoon Jin Cha, MD, PhD, Byoung Chul.

Appropriateness of Surgical Approach in Black Patients with Lung Cancer—15 Years Later, Little Has Changed Emanuela Taioli, MD, PhD, Raja Flores, MD

Jennifer L. Dallas, MD, Michael A. Jantz, MD, Judith L

Combination Treatment Using an EGFR Tyrosine Kinase Inhibitor plus Platinum-Based Chemotherapy for a Patient with Transformed Small Cell Carcinoma and.

An Unmet Need in the WHO 2015 Biopsy Classification: Poorly Differentiated NSCCs with Positive Neuroendocrine Markers Jules L. Derks, MD Journal of.

Osimertinib for Epidermal Growth Factor Receptor Mutation–Positive Lung Adenocarcinoma That Transformed to T790M-Positive Squamous Cell Carcinoma Naoyuki.

Tumor Response Kinetics after Schedule-Dependent Paclitaxel Chemoradiation Treatment for Inoperable Non-small Cell Lung Cancer: A Model for Low-Dose.

Jeffrey Bradley, MD Journal of Thoracic Oncology

Does Lymph Node Metastasis Have a Negative Prognostic Impact in Patients with NSCLC and M1a Disease? Chenyang Dai, MD, Yijiu Ren, MD, Dong Xie, MD, PhD,

Compound Uncommon EGFR Mutations in a Patient with Advanced NSCLC and Durable Response to Sequential EGFR Targeted Therapies Mary Linton B Peters, MD,

Angiosarcoma Arising from Right Atrium: Remarkable Response to Concurrent Chemoradiotherapy with Carboplatin and Paclitaxel Akito Hata, MD, Nobuyuki.

Antiangiogenesis Induced Tumor Cavitation in Lung Cancer

Acquired Mechanism of Crizotinib Resistance in NSCLC with MET Exon 14 Skipping Wei Jin, MD, Benjie Shan, MD, Hu Liu, PhD, Shoubing Zhou, PhD, Wenjuan.

Journal of Thoracic Oncology

Tumor Lysis Syndrome in Limited-Stage Small-Cell Lung Cancer

Lack of FDG Uptake in Small Cell Carcinoma Associated with ANNA-1 Positive Paraneoplastic Autonomic Neuropathy Matthew S. Block, MD, PhD, Robert Vassallo,

Circulating Tumor DNA Identifies EGFR Coamplification as a Mechanism of Resistance to Crizotinib in a Patient with Advanced MET-Amplified Lung Adenocarcinoma

Secondary Resistance to Erlotinib: Acquired T790M Mutation and Small-Cell Lung Cancer Transformation in the Same Patient Vincent Fallet, MD, Anne-Marie.

Journal of Thoracic Oncology

Presentation transcript:

Small Cell Lung Cancer Transformation as a Mechanism of Resistance to PD-1 Therapy in KRAS-Mutant Lung Adenocarcinoma: A Report of Two Cases Wade T. Iams, MD, Kathryn E. Beckermann, MD, PhD, Karinna Almodovar, PhD, Jennifer Hernandez, BS, Cindy Vnencak-Jones, PhD, Lee P. Lim, PhD, Christopher K. Raymond, PhD, Leora Horn, MD, Christine M. Lovly, MD, PhD Journal of Thoracic Oncology Volume 14, Issue 3, Pages e45-e48 (March 2019) DOI: 10.1016/j.jtho.2018.11.031 Copyright © 2018 International Association for the Study of Lung Cancer Terms and Conditions

Figure 1 Case 1. Chronological summary of therapies, imaging studies, and available pathologic findings from diagnosis of adenocarcinoma to transformation to small cell carcinoma. (A) The patient received four cycles of carboplatin and paclitaxel (C/P) followed by a 17-month therapy holiday. She then received 36 cycles of nivolumab every 2 weeks with an initial response, and 2 weeks after her 36th dose of nivolumab she had widespread disease progression, with a biopsy revealing transformation to small cell carcinoma. She went on to receive six cycles of carboplatin and etoposide (C/E) and had a partial response. Two months after completion of C/E therapy she had disease progression and received eight cycles of paclitaxel with a response in her thoracic disease, but she had progression in the central nervous system after her death 11 months after the small cell transformation. (B) Treatment responses were observed in the primary right upper lobe nodule (red arrow) to both carboplatin and paclitaxel and nivolumab, followed by widespread progression, including in the right upper lobe nodule (red arrow), at the time of transformation to small cell carcinoma. (C) Pathologic findings from a level 4R lymph node at the time of diagnosis demonstrated poorly differentiated adenocarcinoma. Cytologic examination of the pericardial fluid at the time of transformation demonstrated small cell carcinoma that was confirmed by synaptophysin immunohistochemistry. Journal of Thoracic Oncology 2019 14, e45-e48DOI: (10.1016/j.jtho.2018.11.031) Copyright © 2018 International Association for the Study of Lung Cancer Terms and Conditions

Figure 2 Case 2. Chronological summary of therapies, imaging studies, and available pathologic findings from diagnosis of adenocarcinoma to transformation to small cell carcinoma. (A) The patient received six cycles of carboplatin, pemetrexed, and bevacizumab (C/P/B), followed by seven cycles of pemetrexed and bevacizumab (P/B) maintenance therapy. She experienced disease progression after a 16-month therapy holiday. She received 33 cycles of second-line nivolumab with disease stabilization, and after an 11-month therapy holiday she progressed with transformation to small cell carcinoma. She received four cycles of carboplatin and etoposide (C/E) with disease stabilization and then experienced disease progression 4 months after completion of C/E therapy. She received three cycles of nivolumab and ipilimumab (N/I) with disease progression, after which she received 10 cycles of irinotecan (I) with initial disease stabilization. After 10 cycles of irinotecan she had further disease progression; she then transitioned to hospice care, dying 16 months after small cell transformation. (B) The patient’s disease was primarily measured by upper lobe ground glass opacities. She experienced a partial response (according to the Response Criteria in Solid Tumors) with first-line therapy, followed by disease stabilization while she was receiving second-line nivolumab. She had asymptomatic diffuse progression of her bilateral ground glass opacities at the time of transformation to small cell carcinoma. (C) Pathologic findings from a left lower lobe lesion at the time of diagnosis demonstrated lung adenocarcinoma. Pathologic findings from a right lower lobe lesion at the time of first progression revealed lung adenocarcinoma consistent with the prior diagnosis. Pathologic findings from a station 7 lymph node at the time of second progression demonstrated small cell carcinoma that was confirmed by synaptophysin immunohistochemistry. Journal of Thoracic Oncology 2019 14, e45-e48DOI: (10.1016/j.jtho.2018.11.031) Copyright © 2018 International Association for the Study of Lung Cancer Terms and Conditions