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5 slides generated from the cancer page, with a quiz from the open benchmark and speaker notes that cite the sources. Arrow keys move between slides; Print gives one slide per page.
Sarcomatoid carcinoma is a rare, aggressive form of lung cancer in which part or all of the tumour looks like a sarcoma, with spindle-shaped or giant cells. It is treated like other non-small-cell lung cancers, but is worth testing for a MET gene fault, which is found in a sizeable minority and can be treated with a tablet.
The WHO classification groups five poorly differentiated non-small-cell carcinomas under sarcomatoid carcinoma: pleomorphic carcinoma (a carcinoma with at least 10 percent spindle or giant cells), spindle cell carcinoma, giant cell carcinoma, carcinosarcoma (carcinoma with true sarcoma such as bone, cartilage or skeletal muscle) and pulmonary blastoma, which has its own page (Nicholson 2022). Patients are mostly men who smoke: in the French series of 93 cases, 77 percent were men, median age 63, 84 percent smokers, and about 70 percent presented with locally advanced or metastatic disease; median survival after surgery was 16.4 months and distant recurrence was common (Vieira 2016).
How it differs from its parent: it is the most treatment-refractory histology of non-small-cell lung cancer, and it carries MET alterations far more often. Whole-exome sequencing of pulmonary sarcomatoid carcinoma found MET exon 14 skipping mutations at high frequency, and a patient with advanced disease responded to the MET inhibitor crizotinib (Liu 2016); a later multicentre study of 124 resected cases found MET exon 14 skipping in 7.3 percent, MET amplification in 4.8 percent and MET protein overexpression in 20.2 percent, the exon 14 cases being pleomorphic, spindle cell and carcinosarcoma (Translational Oncology 2020).
| Setting | Approach | Guideline |
|---|---|---|
| All stages | Treated as non-small-cell lung cancer by stage; MET exon 14 skipping treated on the MET-altered page with capmatinib or tepotinib. | not mapped |