Complete response to chemoimmunotherapy with bevacizumab in synchronous multiple primary cancers: pulmonary adenocarcinoma and sarcomatoid carcinoma

Sep 24, 2026

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A small subset of patients present with synchronous multiple primary cancers, and evidence on how to deliver immunotherapy when more than one cancer coexists remains limited. This report outlines the use of next-generation sequencing and immune biomarkers, including PD-L1, to guide individualized management for synchronous primary pulmonary adenocarcinoma and pulmonary sarcomatoid carcinoma. The case describes a patient with dual synchronous primaries and brain metastasis who achieved complete response after three cycles of carboplatin, paclitaxel, bevacizumab, and atezolizumab, with no evidence of disease after 18 months of maintenance therapy.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages11

Reading Time28 min

AccessFree to download

Introduction

Results

Clinical Presentation

C O L D S P R I N G H A R B O R Molecular Case Studies RESEARCH REPORT Corresponding author: [rsalgia@coh.org](rsalgia@coh.org) | © 2023 Garcia et al. This article is distributed under the terms of the Creative Commons Attribution-NonCommercial License, which permits reuse andredistribution, except for commercial purposes, provided that the original author and source are credited. | | --- | | Ontology terms: lung adenocarcinoma; neoplasm of the lung | Published by Cold Spring Harbor Laboratory Press doi:10.1101/mcs.a006262 Complete response to chemoimmunotherapy with bevacizumab in synchronous multiple primary cancers: pulmonary adenocarcinoma and sarcomatoid carcinoma Diogo Garcia,1,6 Isa Mambetsariev,1 Jeremy Fricke,1 Daniel Schmolze,2 Michelle Afkhami,2 Rifat Mannan,2 Pauline Kim,3 Shaira Therese Dingal,1 Bao Nguyen,4 Razmig Babikian,1 Yuman Fong,5 and Ravi Salgia1 1Department of Medical Oncology, 2Department of Pathology, 3Department of Ambulatory Pharmacy, 4Department of Diagnostic Radiology, 5Department of Surgery, City of Hope, Duarte, California 91010, USA Abstract A small percentage of patients have multiple synchronous primary cancers at presentation. In the last five years, many regimens associated with immunotherapy and chemotherapy were approved for first-line metastatic non-small-cell lung cancer (NSCLC) and other solid tumors, but the study of immunotherapy when multiple cancers are present in one patient remains incomplete. Next-generation sequencing biomarkers and immunotherapy markers including PD-L1 can be effectively utilized in the diagnosis and treatment plan for multiple synchronous primary cancers. Immune biomarkers and PD-L1 expression warrant individualized treatments in synchronous primary adenocarcinoma and pulmonary sarcomatoid carcinoma. We describe the case of a patient with pulmonary sarcomatoid carcinoma and lung adenocarcinoma, metastatic to brain de novo. The patient achieved a complete response after only three cycles of carboplatin, paclitaxel, bevacizumab, and atezolizumab and remains free of any evidence of disease after 18 mo of maintenance therapy. INTRODUCTION For both men and women, lung cancer continues to be the leading cause of cancer-related deaths; reportedly up to 21% of lung cancer patients develop multiple synchronous primary cancers; and there has been an increase in the number of patients diagnosed with double primary cancers (Ferguson 1993; Noh et al. 2008; Lee et al. 2010; Weir et al. 2013) . These rates of multiple primary cancers vary across tumor subtypes, age, exposure such as smoking history, and underlying germline factors and mutations (Travis et al. 2013) . The reported increase in these rates is not yet completely defined, and factors such as improved diagnostic tests and more sophisticated treatment could be a potential cause (Coyte et al. 2014) . 6Present address: Dayan-Daycoval Family Hematology and Oncology Center, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil Cite this article as Garcia et al. 2023 Cold Spring Harb Mol Case Stud 9: a006262 1 of 11 C O L D S P R I N G H A R B O R Molecular Case Studies Complete response in multiple primary cancers However, occurrence of synchronous multiple primary cancers at presentation, with involvement in the lung, have been reported at higher rates, with one study showing 47% of lung patients diagnosed with multiple cancers (Kim et al. 2015b) . Since the rapid adoption of next-generation sequencing of tumor tissue and circulating tumor DNA, it has become more common to study the genomic mutations associated with multiple primary cancersand understand the tumor heterogeneity associated with individual tumor subtypes (Whitworth et al. 2018; Mandelker and Ceyhan-Birsoy 2020) . This advent has helped not only identify the individual tumor sites but also identify potential treatment options for these patients (Vogt et al. 2017) . In our case, we identify a patient who was dia

FAQs

Why is individualized treatment important in synchronous multiple primary lung cancers?

Because immune biomarkers such as PD-L1 and sequencing markers can help tailor immunotherapy and treatment selection when multiple tumors coexist. The report emphasizes individualized management for synchronous adenocarcinoma and sarcomatoid carcinoma.

What biomarkers were highlighted as useful for diagnosis and treatment planning?

Next-generation sequencing biomarkers and immunotherapy-related biomarkers, including PD-L1 expression, are described as effective tools to support diagnosis and therapy planning in multiple synchronous primary cancers.

What treatment led to complete response in the presented case?

The patient achieved complete response after three cycles combining carboplatin, paclitaxel, bevacizumab, and atezolizumab, and remained free of evidence of disease after 18 months of maintenance therapy.

Sep 24, 2026

Uploaded by Ophelia