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CASE REPORT article

Front. Immunol.

Sec. Cancer Immunity and Immunotherapy

This article is part of the Research TopicCommunity Series in Unveiling the Next Generation of Cancer Immunity & Immunotherapy in Lung Cancer: Volume IIView all 11 articles

Sequential Anlotinib and Camrelizumab Combination Therapy Achieves Exceptional Survival in Multi-Driver Mutated, TMB-Low/PD-L1-Low/MSS Pulmonary Sarcomatoid Carcinoma: Case Report and Literature Review

Provisionally accepted
Jun ZhuJun Zhu1Ai ZhuAi Zhu1Li GangLi Gang2Lidong LiuLidong Liu2Zi-Ran GaoZi-Ran Gao3Jiayun LiuJiayun Liu1Yunfei YeYunfei Ye1Xunzhi ZhuXunzhi Zhu1Yi LiYi Li1Hong ChenHong Chen1Huang MeijinHuang Meijin1*
  • 1Department of Oncology, The 920th Hospital of Joint Logistics Support Force, Kunming, China
  • 2Kunming Medical University, Kunming, China
  • 3Department of Pathology, The 920th Hospital of Joint Logistics Support Force, Kunming, China

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Pulmonary sarcomatoid carcinoma (PSC) is a rare and aggressive subtype of non-small cell lung cancer (NSCLC) whose molecular characteristics and therapeutic strategies remain poorly defined. This case report documents an exceptional 72-month overall survival in a 40-year-old male patient with stage IVa pulmonary sarcomatoid carcinoma (PSC). The patient harbored seven coexisting driver mutations [ROS1, RET(exon16,exon19), TSC2, ALK, STK11, PTEN] and exhibited triple-negative immunosuppressive biomarkers: low PD-L1 expression (TPS 3%), low tumor mutational burden (TMB, 11mut/Mb), and microsatellite stable (MSS) status. Sequential anlotinib (anti-angiogenic drug) and camrelizumab (PD-1 inhibitor) combination therapy overcame three biological barriers: (1) angiogenesis inhibition reversed PD-L1 primary resistance by remodeling the tumor microenvironment; (2) treatment induced neoantigens bypassed TMB-L/MSS limitations; (3) multi-target synergy against seven driver mutations. This approach resulted in unprecedented survival outcomes: the 72-month overall survival dramatically exceeds the median OS of less than 12 months reported for advanced PSC, and the patient maintained a progression-free survival of over 37 months on combination therapy, surpassing historical PFS benchmarks. This case provides a clinically actionable framework for managing multi-driver mutated, immunoresistant PSC.

Keywords: Anlotinib, camrelizumab, case report, gene mutation, Pulmonary sarcomatoid carcinoma

Received: 05 Oct 2025; Accepted: 16 Dec 2025.

Copyright: © 2025 Zhu, Zhu, Gang, Liu, Gao, Liu, Ye, Zhu, Li, Chen and Meijin. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Huang Meijin

Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.

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