Case Report: Histological Transformation to Atypical Carcinoid in RET Fusion-positive NSCLC Following Immune Therapy Resistance.
10.3779/j.issn.1009-3419.2025.102.14
- Author:
Yu ZHANG
1
;
Hui ZHANG
2
;
Wei ZHONG
1
;
Minjiang CHEN
1
;
Mengzhao WANG
1
Author Information
1. Department of Respiratory and Critical Care Medicine, Peking Union Medical College Hospital,
Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China.
2. Department of Pathology, Peking Union Medical College Hospital,
Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China.
- Publication Type:English Abstract
- Keywords:
Atypical carcinoid;
Histological transformation;
Immune resistance;
Lung neoplasms;
Selective RET inhibitors
- MeSH:
Humans;
Carcinoid Tumor/drug therapy*;
Carcinoma, Non-Small-Cell Lung/immunology*;
Drug Resistance, Neoplasm;
Immune Checkpoint Inhibitors/therapeutic use*;
Immunotherapy;
Lung Neoplasms/immunology*;
Oncogene Proteins, Fusion/genetics*;
Proto-Oncogene Proteins c-ret/genetics*
- From:
Chinese Journal of Lung Cancer
2025;28(5):400-404
- CountryChina
- Language:Chinese
-
Abstract:
Immune checkpoint inhibitors (ICIs) have become the cornerstone of treatment for driver gene-negative advanced non-small cell lung cancer (NSCLC). However, resistance is inevitable, and the underlying mechanisms remain incompletely understood. Histological transformation is a rare but emerging cause of acquired resistance to immunotherapy, with only sporadic case reports documented to date. Here, we report the first case of lung adenocarcinoma that underwent histological transformation to atypical carcinoid following first-line therapy with ICIs combined with chemotherapy, highlighting the critical role of histological lineage switching in mediating NSCLC resistance to ICIs. Notably, the patient harbored a rearranged during transfection (RET) fusion mutation. Subsequent targeted therapy with Selpercatinib after histological transformation demonstrated favorable efficacy, suggesting a potential therapeutic strategy for atypical carcinoid patients with co-occurring rare driver mutations. This case provides a potential therapeutic option for atypical carcinoid patients with rare mutations.
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