Neoadjuvant Chemoradiotherapy Treatment for a Classic Biphasic Pulmonary Blastoma with High PD-L1 Expression

Pulmonary blastomas are rare malignant tumors, comprising only 0.25-0.5% of all malignant lung neoplasms. The prognosis of pulmonary blastoma is very poor, with an overall five-year survival of 16%. No standard treatment has been defined for unresectable disease. We present the case of a 25-year-old...

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Bibliographic Details
Published in:Anticancer research 2015-09, Vol.35 (9), p.4871-4875
Main Authors: Bosch-Barrera, Joaquim, Holguin, Francia, Baldó, Xavier, Rubio, Matilde, Porta, Rut, Fuentes, Rafael, Teixidó, Cristina, Ramirez, José Luis, Ferran, Nuria, Sebastián, Fernando, Rosell, Rafael
Format: Article
Language:English
Subjects:
Adult
B7-H1 Antigen - metabolism
Female
Humans
Immunohistochemistry
Lung Neoplasms - diagnostic imaging
Lung Neoplasms - metabolism
Lung Neoplasms - therapy
Neoadjuvant Therapy
Positron-Emission Tomography
Pulmonary Blastoma - diagnostic imaging
Pulmonary Blastoma - metabolism
Pulmonary Blastoma - therapy
Tomography, X-Ray Computed
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Summary:Pulmonary blastomas are rare malignant tumors, comprising only 0.25-0.5% of all malignant lung neoplasms. The prognosis of pulmonary blastoma is very poor, with an overall five-year survival of 16%. No standard treatment has been defined for unresectable disease. We present the case of a 25-year-old woman with unresectable locally advanced classic biphasic pulmonary blastoma (CBPB) successfully treated with neodjuvant chemoradiotherapy based on two chemotherapy induction cycles of cisplatin plus etoposide, followed by concurrent weekly cisplatin to 50.4 Gy radiotherapy treatment. The patient had a significant reduction in tumor size, allowing for complete resection by pneumonectomy. Molecular study for epidermal growth factor receptor (EGFR) mutations, anaplastic lymphoma kinase (ALK), proto-oncogene receptor tyrosine kinase (ROS1) and rearranged during transfection (RET) rearrangements, and programmed death ligand 1 (PD-L1) expression was performed in the pre-treatment tumor sample. Our patient presented a high expression (>90% of tumor cells) of PD-L1. To our knowledge, this is the first report of PD-L1 expression in CBPB. This could lead to new treatment options based on new immunotherapy agents blocking the PD-1/PD-L1 pathway for this rare disease with poor prognosis.
ISSN:1791-7530