肺肉瘤样癌（PSC）是非小细胞肺癌（NSCLC）的独特亚型，恶性程度高，治疗效果差。近年来，随着免疫检查点抑制剂（ICIs）的广泛使用，很少有研究报道免疫疗法对PSC有效。安罗替尼作为多靶点抗血管靶向药物，在多种癌种中均表现出较好的抗肿瘤效果。该论文报道了派姆单抗联合安罗替尼治疗晚期 PSC 患者的治疗效果和副作用。该患者为 73 岁女性患者，接受胸腔镜右上肺叶切除术，诊断为局部晚期 PSC。然而，患者术后7周肿瘤复发转移，无法耐受放化疗。此外，她检测了TP53突变，发现肿瘤突变负荷（TMB）和PD-L1高表达。因此，患者接受了派姆单抗联合安罗替尼治疗。治疗15个周期后，肿瘤明显缩小，无肿瘤活性。肿瘤疗效的评价为部分缓解（PR）。治疗期间，她出现了一级促甲状腺激素升高和二级手足综合征。派姆单抗和安罗替尼继续作为维持治疗两年。患者生活质量良好，未观察到疾病进展。目前，患者仍存活，肿瘤未进展，总生存期超过45个月，毒副作用可耐受。ICIs与抗血管生成靶向治疗相结合，为晚期PSC的治疗带来了新的希望。此外，TMB 和 PD-L1 表达可能是晚期 PSC 免疫治疗疗效的潜在预测生物标志物。版权所有 © 2023 Wu、Wu、Liao、Zhou、Qiu、Wang 和zhong。

Pulmonary sarcomatoid carcinoma (PSC) is a unique subtype of non-small cell lung cancer (NSCLC) with a high degree of malignancy and poor therapeutic effects. With the widespread use of immune checkpoint inhibitors (ICIs) in recent years, few studies have reported that immunotherapy is effective against PSC. As a multi-target anti-vascular targeting agent, anlotinib showed a better anti-tumor effect in various cancer species. The paper reported the therapeutic and side effects of pembrolizumab combined with anlotinib in a patient with advanced PSC.This is a 73 year old female patient who underwent thoracoscopy right upper lobectomy and was diagnosed as locally advanced PSC. However, the patient experienced tumor recurrence and metastasis 7 weeks after surgery and was unable to tolerate chemoradiotherapy. Moreover, she detected TP53 mutation and found that tumor mutation burden (TMB) and PD-L1 were high expression. Therefore, the patient received pembrolizumab combined with anlotinib treatment. After 15 cycles of treatment, the tumor significantly shrank with no tumor activity. The evaluation of tumor efficacy is partial response (PR). During the treatment period, she experienced one-degree thyroid-stimulating hormone elevation and two-degree hand-foot syndrome. Pembrolizumab and anlotinib was continued for two years as a maintenance treatment. The patient had a good quality of life and no disease progression was observed. Currently, the patient is still alive without tumor progression and has overall survival exceeding 45 months and toxic side effects were tolerable.Combining ICIs and anti-angiogenic targeted therapy has brought new hope in treating advanced PSC. Additionally, TMB and PD-L1 expression could be potential predictive biomarkers of the efficacy in advanced PSC with immunotherapy.Copyright © 2023 Wu, Wu, Liao, Zhou, Qiu, Wang and Zhong.