Supplementary Material for: Pulmonary spindle cell carcinoma presenting anaplastic lymphoma kinase rearrangement

Pulmonary spindle cell carcinoma is a subtype of pulmonary sarcomatoid carcinoma and a very rare tumor type with a poor prognosis. A few case reports have documented patients with pulmonary sarcomatoid carcinoma with anaplastic lymphoma kinase rearrangement, and the efficacy and outcomes of anaplastic lymphoma kinase inhibitors remain unclear. Herein, we present the case of a 60-year-old woman with stage IVB disease who was diagnosed with a metastatic brain tumor. This patient showed high levels of programmed cell death ligand 1 expression and anaplastic lymphoma kinase rearrangement and received pembrolizumab as the first-line treatment. Three weeks later, pembrolizumab failed to reduce the size of the primary pulmonary tumor, and the patient’s general condition did not improve. The patient received alectinib as the second-line treatment. Two months later, multiple brain metastases were observed. Hence, whole-brain irradiation was performed as treatment for multiple brain metastases, while another anaplastic lymphoma kinase inhibitor was administered; however, both treatments remained ineffective. The patient eventually died 9 months after the initiation of first-line treatment. The present case report describes the therapeutic course of a patient with pulmonary spindle cell carcinoma with an anaplastic lymphoma kinase rearrangement.

肺梭形细胞癌（Pulmonary spindle cell carcinoma）是肺肉瘤样癌（pulmonary sarcomatoid carcinoma）的一个亚型，属于预后极差的罕见肿瘤类型。目前已有少数病例报告记录了伴间变性淋巴瘤激酶（anaplastic lymphoma kinase, ALK）重排的肺肉瘤样癌患者，而ALK抑制剂的疗效与临床结局仍不明确。本文报告1例60岁IVB期肺梭形细胞癌女性患者，确诊伴脑转移瘤。该患者程序性死亡受体配体1（programmed cell death ligand 1, PD-L1）高表达，且存在ALK重排，一线治疗予以帕博利珠单抗（pembrolizumab）。治疗3周后，帕博利珠单抗未能缩小肺部原发肿瘤体积，患者一般状况未获改善。遂予阿来替尼（alectinib）作为二线治疗方案。2个月后，复查发现患者出现多发脑转移，因此针对多发脑转移予以全脑放疗（whole-brain irradiation），同时加用另一种ALK抑制剂，但两种治疗方案均未取得疗效。患者最终于一线治疗启动后9个月死亡。本病例报告详述了1例伴ALK重排的肺梭形细胞癌患者的诊疗全过程。