title: Efficacy of first-line chemotherapy in patients with advanced lung sarcomatoid carcinoma.
abstract: BACKGROUND
  Sarcomatoid carcinomas (SCs) are rare tumors that may arise in the lung, accounting for 0.4% of non-small-cell lung cancers; the prognosis is poor. Only few retrospective small-size series have studied the efficacy of chemotherapy (CT) for metastatic SC.
  
  
  METHODS
  Multicenter study of patients with advanced or metastatic SC who received first-line CT. Clinical characteristics at baseline, response to first-line CT (Response Evaluation Criteria in Solid Tumors version 1.1), progression-free survival (PFS), and overall survival (OS) were retrospectively collected.
  
  
  RESULTS
  Ninety-seven patients were included. Median age was 62 (54-72) years. The majority of patients were men (70%), white (84%), and smokers (84%). Overall, 73% of patients received first-line platinum-based CT. At first tumor evaluation, 69% of patients experienced progression, 31% had disease control, and 16.5% had partial response. Partial response was observed in 20% of patients receiving platinum-based CT, and in none of those receiving non-platinum-based CT (p = 0.018). Median PFS was 2.0 months (confidence interval [CI] 95%: 1.8-2.3). PFS was not statistically different between patients receiving or not receiving a platinum-based CT. Median OS was 6.3 months (CI 95%: 4.7-7.8). There was a trend toward better OS for patients treated with platinum-based CT (7.0 months [CI 95%: 4.9-9.0] versus 5.3 months [CI 95%: 2.8-7.6]; p = 0.096). In multivariate analysis, disease control at first evaluation (hazard ratio = 0.38 [CI 95%: 0.21-0.59]) and at platinum-based CT (hazard ratio = 0.92 [CI 95%: 0.85-0.99]) was associated with better OS.
  
  
  CONCLUSIONS
  SC is associated with poor prognosis and high rate of resistance to conventional first-line CT. New therapeutic strategies are needed, based on better knowledge of the carcinogenesis of SC.
authors.affiliation: Departments of *Pneumology and **Pathology, Hospital Tenon, APHP, Paris, France; †Laboratory ER2 et GRC-04 UPMC, Paris, France; ‡Department of Respiratory Medicine, Hospital Louis Pradel, Hospices Civils de Lyon, Lyon, France; §Department of Pneumology, Hospital Larrey, CHU Toulouse, Université de Toulouse III, Toulouse, France; ‖Department of Pneumology, Intercommunal Hospital Center, Créteil, France; ¶Department of Pathology, Hospital Georges Pompidou, APHP, Paris, France; and #Department of Thoracic Surgery, Hospital Foch, Suresnes, France.
authors.forename: Thibault
authors.initials: T
authors.lastname: Vieira
authors.forename: Nicolas
authors.initials: N
authors.lastname: Girard
authors.forename: Mony
authors.initials: M
authors.lastname: Ung
authors.forename: Isabelle
authors.initials: I
authors.lastname: Monnet
authors.forename: Aurélie
authors.initials: A
authors.lastname: Cazes
authors.forename: Pierre
authors.initials: P
authors.lastname: Bonnette
authors.forename: Michael
authors.initials: M
authors.lastname: Duruisseaux
authors.forename: Julien
authors.initials: J
authors.lastname: Mazieres
authors.forename: Martine
authors.initials: M
authors.lastname: Antoine
authors.forename: Jacques
authors.initials: J
authors.lastname: Cadranel
authors.forename: Marie
authors.initials: M
authors.lastname: Wislez
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002296:Carcinosarcoma / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D003841:Deoxycytidine / Q000008:administration & dosage / Q000031:analogs & derivatives; D000077143:Docetaxel; D000069347:Erlotinib Hydrochloride; D005260:Female; D005500:Follow-Up Studies; D005870:Giant Cell Tumors / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D005971:Glutamates / Q000008:administration & dosage; D006147:Guanine / Q000008:administration & dosage / Q000031:analogs & derivatives; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D017239:Paclitaxel / Q000008:administration & dosage; D000068437:Pemetrexed; D011379:Prognosis; D011799:Quinazolines / Q000008:administration & dosage; D012189:Retrospective Studies; D012509:Sarcoma / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D015996:Survival Rate; D043823:Taxoids / Q000008:administration & dosage; D014747:Vinblastine / Q000008:administration & dosage / Q000031:analogs & derivatives; D000077235:Vinorelbine; D000093542:Gemcitabine
chemical_list: D005971:Glutamates; D011799:Quinazolines; D043823:Taxoids; D000068437:Pemetrexed; D003841:Deoxycytidine; D000077143:Docetaxel; D014747:Vinblastine; D006147:Guanine; D000069347:Erlotinib Hydrochloride; D017239:Paclitaxel; D000077235:Vinorelbine; D000093542:Gemcitabine