Prolonged survival in a 57-year-old female with RB1-wildtype transformed small-cell lung cancer treated with immunochemotherapy and antiangiogenic combined therapy: a case report.

Authors

Liping Kang, Liping Zhao, Xiaolong Chen, Ning Kang, Peiyun Long, Cong Kang, Jianhong Li, Guoping Zhang

Published in

AME case reports. Volume 10. Pages 179. Epub Jul 16, 2026.

Abstract

The transformed small-cell lung cancer (T-SCLC) has a dismal prognosis, yet there remains a lack of standardized therapeutic guidelines. While this transformation is predominantly driven by concurrent loss of TP53 and RB1, retaining wild-type RB1 is exceptionally rare. We report a rare case of RB1-wildtype T-SCLC with prolonged survival to highlight its diagnostic challenges, potential biological mechanisms, and therapeutic management.
A 57-year-old non-smoking woman with no significant prior medical history presented with persistent dizziness, headaches, and vomiting. She was diagnosed with EGFR-mutant stage IV lung adenocarcinoma (LADC; EGFR L858R/R776H, PIK3CA E542K, TP53 C176F; RB1 wild-type) following surgical resection of brain metastases. Primary lung biopsy was not feasible due to deep tumor location and marked vascularity. She received sequential dacomitinib [progression-free survival (PFS): 14 months] and osimertinib (PFS: 9 months), monitored by serial imaging and dynamic serum neuron-specific enolase (NSE). Rising NSE prompted re-biopsy of a liver metastasis, confirming small-cell lung cancer (SCLC) transformation at 35 months. She then received serplulimab, anlotinib, etoposide, and carboplatin; significant tumor regression was observed after two cycles, though grade 3-4 hematologic toxicities after the third cycle resolved with supportive care. Liver progression after six cycles prompted second-line nab-paclitaxel plus serplulimab and anlotinib, achieving renewed disease control for over 3 months. Treatment adherence was generally good throughout the clinical course. Overall survival (OS) was 5 years and 4 months, with post-transformation survival of 14 months.
This case highlights a rare RB1-wildtype transformation from EGFR-mutant LADC to SCLC, suggesting a distinct mechanism of lineage plasticity. Dynamic NSE elevation may serve as an early clinical indicator of transformation when tissue re-biopsy is challenging. The durable response achieved with serplulimab-based chemoimmunotherapy combined with anlotinib provides preliminary support for immunotherapy-based strategies in selected patients with T-SCLC.

PMID:
42871379
Bibliographic data and abstract were imported from PubMed on 14 Oct 2026.

Read full publication at:
Please sign in to see all details.

Stats

1-terrible, 9-excellent. How would you rate this publication? Sign in in to submit your rating.

Post a comment

You need to be signed in to post comments. You can sign in here.

Comments

There are no comments yet.