Review and case report: Hepatoid adenocarcinoma of the lung treated with nivolumab metastatizing to the skin

• Autores: Bárbara Cancela Díez, Felix Gómez de Rueda, Javier Valdivia Bautista, José Aneiros Fernández, Alberto Jiménez Morales
• Localización: European journal of clinical pharmacy: atención farmacéutica, ISSN 2385-409X, Vol. 21, Nº. 3, 2019, págs. 149-154
• Idioma: inglés
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• Resumen

  • Background: Hepatoid adenocarcinoma of the lung (HAL) is a rare tumor that histologically resembles hepatocellular carcinoma (HCC) when it is metastatic to the lung. Nodal and distant metastases are common, so the prognosis is poor. No clear consensus exists as to the appropriate treatment but the most common treatment for HAL is surgical resection, chemotherapy and/or radiotherapy. However, other therapies such as immunotherapy anti programmed cell death receptor-1(PD-1) or tyrosine kinase inhibitors are rarely used.

    Purpose: To present a case of (HAL) with cutaneous metastasis during second- line treatment with nivolumab and summarize findings of the previous cases reported up to date, describing clinical, histopathologic features and treatment applied.

    Method: We conducted a systematic review in the Embase and PubMed database to identify all articles of HAL described in the English literature.

    Results: A 63-year-old ex-smoker patient with non-small cell adenocarcinoma of the lung, stage IV, EGFR and ALK negative. The patient was treated with a regime of carboplatin-gemcitabine chemotherapy and radiotherapy with low hematological tolerance and tumor progression, as a result, second-line treatment commenced with nivolumab. After the second nivolumab cycle the patient developed cutaneous nodules with a scar-like appearance in the torso, extremities and scalp. The pathological diagnostic confirmed adenocarcinoma hepatoid cutaneous metastasis with pulmonary origin. Eventually, the patient died within seven months from the onset of the disease. Including our patient, we found 36 articles describing HAL. All cases reported, except one were male. The mean age was 60 (range 36-79). A high proportion of patients (20) were smokers or had a smoker history. The tumor size range to 1.8 to 14 cm with a mean size of 8 cm. Regarding the immunohistochemical staining, we found that CK7, CK19 and Hep-Par1 were positive in most cases. AFP levels range to normal (two cases) to 16,978.72 ng/ml.

    Conclusion: HAL is a rare tumor and it is difficult to distinguish with HCC when it is metastatic to the lung. HAL usually produces high levels of AFP, but this feature is not presented in all HAL cases, consequently, immunohistochemical staining is essential for the diagnosis. The prognosis is poor and there is no consensus on standard treatment, but recently other different treatments than chemotherapy have been used, although results are not conclusive