Conversion Surgery for Advanced Thoracic SMARCA4-Deficient Undifferentiated Tumor With Atezolizumab in Combination With Bevacizumab, Paclitaxel, and Carboplatin Treatment: A Case Report

Kei Kunimasa, MD, PhD; Jiro Okami, MD, PhD; Satoshi Takenaka, MD, PhD; Keiichiro Honma, MD, PhD; Yoji Kukita, PhD; Shigenori Nagata, MD, PhD; Takahisa Kawamura, MD, PhD; Takako Inoue, MD; Motohiro Tamiya, MD; Hanako Kuhara, MD, PhD; Kazumi Nishino, MD, PhD; Hideaki Tahara, MD, PhD; Toru Kumagai, MD, PhD

JTO Clinical and Research Reports (Nov 2021)

Conversion Surgery for Advanced Thoracic SMARCA4-Deficient Undifferentiated Tumor With Atezolizumab in Combination With Bevacizumab, Paclitaxel, and Carboplatin Treatment: A Case Report

Kei Kunimasa, MD, PhD,
Jiro Okami, MD, PhD,
Satoshi Takenaka, MD, PhD,
Keiichiro Honma, MD, PhD,
Yoji Kukita, PhD,
Shigenori Nagata, MD, PhD,
Takahisa Kawamura, MD, PhD,
Takako Inoue, MD,
Motohiro Tamiya, MD,
Hanako Kuhara, MD, PhD,
Kazumi Nishino, MD, PhD,
Hideaki Tahara, MD, PhD,
Toru Kumagai, MD, PhD

Affiliations

Kei Kunimasa, MD, PhD: Department of Thoracic Oncology, Osaka International Cancer Institute, Osaka, Japan; Corresponding author. Address for correspondence: Kei Kunimasa, MD, PhD, Department of Thoracic Oncology, Osaka International Cancer Institute, 3-1-69 Otemae Chuoku, Osaka City, Osaka 541-8567, Japan.
Jiro Okami, MD, PhD: Department of General Thoracic Surgery, Osaka International Cancer Institute, Osaka, Japan
Satoshi Takenaka, MD, PhD: Musculoskeletal Oncology Service, Osaka International Cancer Institute, Osaka, Japan
Keiichiro Honma, MD, PhD: Department of Diagnostic Pathology and Cytology, Osaka International Cancer Institute, Osaka, Japan
Yoji Kukita, PhD: Laboratory of Genomic Pathology, Osaka International Cancer Institute, Osaka, Japan
Shigenori Nagata, MD, PhD: Department of Diagnostic Pathology and Cytology, Osaka International Cancer Institute, Osaka, Japan
Takahisa Kawamura, MD, PhD: Department of Thoracic Oncology, Osaka International Cancer Institute, Osaka, Japan
Takako Inoue, MD: Department of Thoracic Oncology, Osaka International Cancer Institute, Osaka, Japan
Motohiro Tamiya, MD: Department of Thoracic Oncology, Osaka International Cancer Institute, Osaka, Japan
Hanako Kuhara, MD, PhD: Department of Thoracic Oncology, Osaka International Cancer Institute, Osaka, Japan
Kazumi Nishino, MD, PhD: Department of Thoracic Oncology, Osaka International Cancer Institute, Osaka, Japan
Hideaki Tahara, MD, PhD: Department of Cancer Drug Discovery and Development, Research Center, Osaka International Cancer Center, Osaka, Japan; Project Division of Cancer Biomolecular Therapy, Institute of Medical Science, The University of Tokyo, Tokyo, Japan
Toru Kumagai, MD, PhD: Department of Thoracic Oncology, Osaka International Cancer Institute, Osaka, Japan

Journal volume & issue: Vol. 2, no. 11
p. 100235

Abstract

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A SMARCA4-deficient undifferentiated tumor (SMARCA4-UT) is a rapidly progressing subtype of lung cancer with a poor prognosis and causes early postoperative recurrence among operable patients. In this study, we present a case of SMARCA4-UT with vertebral and chest wall invasion that successfully underwent conversion surgery after treatment with atezolizumab in combination with bevacizumab, paclitaxel, and carboplatin. The surgical specimen comprised SMARCA4-deficient and SMARCA2-positive adenocarcinoma, confirming intratumor heterogeneity. Gene panel analysis revealed no substantial differences in mutant gene profiles among tumors and no differences in SMARCA2 mutations. Furthermore, no recurrence occurred for 9 months after surgery. Thus, this case illustrates the possibility of multidisciplinary treatment including neoadjuvant therapy with immunotherapy and conversion surgery for SMARCA4-UT.

Published in JTO Clinical and Research Reports

ISSN: 2666-3643 (Online)
Publisher: Elsevier
Country of publisher: United States
LCC subjects: Medicine: Internal medicine: Neoplasms. Tumors. Oncology. Including cancer and carcinogens
Website: https://www.journals.elsevier.com/jto-clinical-and-research-reports/

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