Small cell transformation of non‐small cell lung cancer under immunotherapy: Case series and literature review

Abstract In advanced lung cancer treatment, immunotherapy provides durable responses in some patients. However, other patients experience progressive disease and the resistance mechanisms to immunotherapy have yet been fully elucidated. Small cell transformation of non‐small cell lung cancer (NSCLC)...

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Autores principales:	Takuma Imakita, Kohei Fujita, Osamu Kanai, Misato Okamura, Masayuki Hashimoto, Koichi Nakatani, Satoru Sawai, Tadashi Mio
Formato:	article
Lenguaje:	EN
Publicado:	Wiley 2021
Materias:	immunotherapy non‐small cell lung cancer rebiopsy small cell transformation Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282
Acceso en línea:	https://doaj.org/article/898c28b337844146befb3de01718af18
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spelling	oai:doaj.org-article:898c28b337844146befb3de01718af182021-11-14T23:28:26ZSmall cell transformation of non‐small cell lung cancer under immunotherapy: Case series and literature review1759-77141759-770610.1111/1759-7714.14180https://doaj.org/article/898c28b337844146befb3de01718af182021-11-01T00:00:00Zhttps://doi.org/10.1111/1759-7714.14180https://doaj.org/toc/1759-7706https://doaj.org/toc/1759-7714Abstract In advanced lung cancer treatment, immunotherapy provides durable responses in some patients. However, other patients experience progressive disease and the resistance mechanisms to immunotherapy have yet been fully elucidated. Small cell transformation of non‐small cell lung cancer (NSCLC) is commonly recognized as one of the resistance mechanisms to epidermal growth factor receptor (EGFR)‐tyrosine kinase inhibitors in EGFR‐mutant NSCLC treatment. As a resistant mechanism for immunotherapy, we report the first case of small cell transformation in 2017. Since then, eight similar cases have been reported and the concept of small cell transformation is now becoming more prevalent as a mechanism of immunotherapy resistance. In our facility, we have experienced four cases of small cell transformation after immunotherapy (including the reported case in 2017). The histology of each primary tumor was squamous cell carcinoma, large cell type neuroendocrine carcinoma, or poorly differentiated NSCLC. None had driver gene mutations. Nivolumab was administered in all four cases and atezolizumab was administered as a next line to nivolumab treatment in one case. The best response to immunotherapy was partial response or stable disease. There was a wide range of periods from the start of immunotherapy to confirmation of small cell transformation (from 2 weeks to almost 3 years). In conclusion, small cell transformation is an important resistance mechanism in cancer immunotherapy. When NSCLC progresses after immunotherapy, the possibility of small cell transformation and rebiopsy should always be encouraged, as it leads to clarification of the resistance mechanisms and frequency.Takuma ImakitaKohei FujitaOsamu KanaiMisato OkamuraMasayuki HashimotoKoichi NakataniSatoru SawaiTadashi MioWileyarticleimmunotherapynon‐small cell lung cancerrebiopsysmall cell transformationNeoplasms. Tumors. Oncology. Including cancer and carcinogensRC254-282ENThoracic Cancer, Vol 12, Iss 22, Pp 3062-3067 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	immunotherapy non‐small cell lung cancer rebiopsy small cell transformation Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282
spellingShingle	immunotherapy non‐small cell lung cancer rebiopsy small cell transformation Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282 Takuma Imakita Kohei Fujita Osamu Kanai Misato Okamura Masayuki Hashimoto Koichi Nakatani Satoru Sawai Tadashi Mio Small cell transformation of non‐small cell lung cancer under immunotherapy: Case series and literature review
description	Abstract In advanced lung cancer treatment, immunotherapy provides durable responses in some patients. However, other patients experience progressive disease and the resistance mechanisms to immunotherapy have yet been fully elucidated. Small cell transformation of non‐small cell lung cancer (NSCLC) is commonly recognized as one of the resistance mechanisms to epidermal growth factor receptor (EGFR)‐tyrosine kinase inhibitors in EGFR‐mutant NSCLC treatment. As a resistant mechanism for immunotherapy, we report the first case of small cell transformation in 2017. Since then, eight similar cases have been reported and the concept of small cell transformation is now becoming more prevalent as a mechanism of immunotherapy resistance. In our facility, we have experienced four cases of small cell transformation after immunotherapy (including the reported case in 2017). The histology of each primary tumor was squamous cell carcinoma, large cell type neuroendocrine carcinoma, or poorly differentiated NSCLC. None had driver gene mutations. Nivolumab was administered in all four cases and atezolizumab was administered as a next line to nivolumab treatment in one case. The best response to immunotherapy was partial response or stable disease. There was a wide range of periods from the start of immunotherapy to confirmation of small cell transformation (from 2 weeks to almost 3 years). In conclusion, small cell transformation is an important resistance mechanism in cancer immunotherapy. When NSCLC progresses after immunotherapy, the possibility of small cell transformation and rebiopsy should always be encouraged, as it leads to clarification of the resistance mechanisms and frequency.
format	article
author	Takuma Imakita Kohei Fujita Osamu Kanai Misato Okamura Masayuki Hashimoto Koichi Nakatani Satoru Sawai Tadashi Mio
author_facet	Takuma Imakita Kohei Fujita Osamu Kanai Misato Okamura Masayuki Hashimoto Koichi Nakatani Satoru Sawai Tadashi Mio
author_sort	Takuma Imakita
title	Small cell transformation of non‐small cell lung cancer under immunotherapy: Case series and literature review
title_short	Small cell transformation of non‐small cell lung cancer under immunotherapy: Case series and literature review
title_full	Small cell transformation of non‐small cell lung cancer under immunotherapy: Case series and literature review
title_fullStr	Small cell transformation of non‐small cell lung cancer under immunotherapy: Case series and literature review
title_full_unstemmed	Small cell transformation of non‐small cell lung cancer under immunotherapy: Case series and literature review
title_sort	small cell transformation of non‐small cell lung cancer under immunotherapy: case series and literature review
publisher	Wiley
publishDate	2021
url	https://doaj.org/article/898c28b337844146befb3de01718af18
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Small cell transformation of non‐small cell lung cancer under immunotherapy: Case series and literature review

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