Treatment for pleomorphic carcinoma - 1268821

dewrama,

Welcome to Grace. I'm very sorry for your dad's diagnosis and let me apologize for the long wait for a response.

I will ask a lung cancer specialist to comment. Rare type lung cancers don’t have data from large studies so optimal treatments just can’t be known.

A second opinion is never a bad idea especially when first diagnosed. Dr. Weiss wrote about that here, http://cancergrace.org/cancer-101/2011/11/13/an-insider%E2%80%99s-guide…

Hope for the best,
Janine

Hello Dewrama--

I am sorry to hear about your father. A "pleomorphic carcinoma" in general means that a tumor contains a mixture of some elements of a more-common lung cancer, in addition to cells that look (under the microscope) more "sarcomatoid" (meaning that there are larger, or "giant" cells, or other types like "spindle cells" seen). The presence of these "sarcomatoid" components are in general what implies a more aggressive cancer.
The description of TTF-1, Napsin, CK-7, in general is part of the description of the pattern of staining that the pathologist uses to help determine where a cancer may have started. This pattern that you are describing above generally indicates that a cancer has started in the lung, and most commonly is seen with adenocarcinomas (which can be a common component of a pleomorphic carcinoma). The staining pattern itself does not determine a pleomorphic tumor, that is part of what the pathologist describes as they are looking at it.

While there are not specific treatments for pleomorphic carcinomas, in general one would consider treating the cancer with the therapy most likely to have effect against the predominant type of cancer cells seen (adenocarcinoma, squamous cell carcinoma, etc). The rarity of the cancers means that there really aren't any specific trials for it.

As Janine stated, second opinions about pathology or treatment are not bad things, and it may help you both feel more confident in the diagnosis.

There really aren't dedicated experts in pleomorphic carcinomas; this is something though that an oncologist who specializes in lung cancer may have seen and treated more frequently just by nature of the numbers.

I hope this helps--

It's possible to have targetable mutations such as EGFR and possibly ALK or ROS1 with pleomorphic nsclc so mutation testing may be in order especially if your dad has a small or no smoking history. At any rate tarceva is a standard option for 2nd line treatment.

Immunotherapy treatments are being tested specifically promising are PD-1 and PD-L1 trials that may be open to your dad. One of these treatments has just been FDA approved for squamous cell nsclc. If it's thought your dad has enough squamous in his cancer that might be an option now.

These options can be addressed in a 2nd opinion (at MD Anderson if it's nearby) with a nsclc specialist. Since both of these options take time and your dad's cancer may well be aggressive enough it might make the most sense to go ahead and start chemo first. I hope you read the most excellent blog post from Dr. Weiss I linked in my first post.

However if he doesn't have symptoms getting that 2nd now would answer all your questions and relieve a lot of stress. For what it's worth if I've learned anything on Grace in the last 6 years, the angst you're feeling is probably small in comparison to what your dad is experiencing. The best oncologists take their patients' psychological needs as well as physical needs into account with making decisions with the patient. A lot of that has to do with there not being enough absolutes in this cancer treatment so maintaining quality is so very important.

We have lots on Grace on the subject of targeted therapies and immunotherapies.

Let us know how things move ahead,
Janine