Palliative Chemotherapy for Patients with Pulmonary Pleomorphic Carcinoma: A Retrospective Single-institutional Study

Objective: Pulmonary pleomorphic carcinoma (PPC) is considered to be highly resistant to conventional standard chemotherapy for non-small cell lung cancer and associated with poor prognosis. Because of its histological rarity, the efficacy of palliative chemotherapy is not well-known. This study aimed to clarify the efficacy of palliative chemotherapy for this rare type of aggressive tumor. Method: We retrospectively reviewed our medical records. We collected data on patients who had been histologically diagnosed of PPC and received palliative chemotherapy between June 2007 and December 2014 at Osaka Police Hospital. Results: Among a total of 1461 primary lung cancers, 29 patients (2.0%) were diagnosed with PPC. Seventeen patients, including 15 males and 3 females, received palliative chemotherapy. Patients had the median age of 67 years (range, 43-80 years) and included twelve stage IV, four stage IIIB and one post-surgical recurrent diseases. Twelve patients received platinum-based regimen, while five were treated with monotherapy. The most frequent regimen in the first-line chemotherapy was combination of carboplatin plus paclitaxel. Response was found in a patient who had been treated with a triple combination of carboplatin, paclitaxel plus bevacizumab. The response rate (RR), disease control rate (DCR), median progression-free survival (PFS), median overall survival (OS) and 1year survival rate of the first-line chemotherapy were 5.9% (95% confidence interval; 0.1-28.7%), 35.3% (14.2-61.7%), 45 days (35-115 days), 179 days (64-303 days) and 19.0% (4.7-40.6%), respectively. Among 15 regimens per 9 patients in the secondand further-line settings, none experienced response. The RR, DCR, median PFS, median OS and 1-year survival rate of the second-line chemotherapy (n=9) were 0% (0-28.3%), 33.3% (7.5-70.1%), 77 days (3-142 days), 144 days (5-331 days) and 11.1% (0.6-38.8%), respectively. Conclusion: Palliative chemotherapy was futile for advanced PPC. Further investigation of a new approach to this aggressive tumor is required.