Utilization of Dual Immunotherapy for Metastatic Pulmonary Pleomorphic Giant Cell Carcinoma: A Case Report

Introduction: Pulmonary Pleomorphic Carcinomas (PPC) are a rare histologic subgroup of sarcomatoid Non-Small Cell Lung Carcinomas (NSCLC). They are characterized by more aggressive growth and elicit a poorer response to antitumor chemotherapy. Furthermore, PPC is associated with an increased likelihood of early metastasis as well as a high risk of relapse. Here, we report the clinical course of a patient with PPC treated with dual immune checkpoint inhibitor therapy and highlight the partial response observed with this approach.

Case Presentation: A 48-year-old male presented with metastatic high-grade pleomorphic giant cell carcinoma.

The liquid biopsy from the original brain lesion revealed no actionable mutations. Next generation sequencing results showed PD-L1 50% and Tumor Mutational Burden (TMB) of 13 mutations per megabase. He was initiated on nivolumab 3 milligrams (mg)/kilogram (kg) every 2 weeks and ipilimumab 1 mg/kg every 6 weeks in a 42-day cycle. He also underwent Stereotactic Radiosurgery (SRS) to the brain lesions. After completing two cycles of treatment, his repeat PET scan showed an overall interval partial response.

Conclusion: Dual immune-checkpoint inhibitor therapy is effective for the treatment of PPC and prospective clinical trials are warranted.