Diogo Garcia1,6, Isa Mambetsariev1, Jeremy Fricke1, Daniel Schmolze2, Michelle Afkhami2, Rifat Mannan2, Pauline Kim3, Shaira Therese Dingal1, Bao Nguyen4, Razmig Babikian1, Yuman Fong5 and Ravi Salgia1 1Department of Medical Oncology, City of Hope, Duarte, California 91010, USA; 2Department of Pathology, City of Hope, Duarte, California 91010, USA; 3Department of Ambulatory Pharmacy, City of Hope, Duarte, California 91010, USA; 4Department of Diagnostic Radiology, City of Hope, Duarte, California 91010, USA; 5Department of Surgery, City of Hope, Duarte, California 91010, USA Corresponding author: rsalgiacoh.org

↵6 Present address: Dayan-Daycoval Family Hematology and Oncology Center, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil

A small percentage of patients have multiple synchronous primary cancers at presentation. In the last five years, many regimens associated with immunotherapy and chemotherapy were approved for first-line metastatic non-small-cell lung cancer (NSCLC) and other solid tumors, but the study of immunotherapy when multiple cancers are present in one patient remains incomplete. Next-generation sequencing biomarkers and immunotherapy markers including PD-L1 can be effectively utilized in the diagnosis and treatment plan for multiple synchronous primary cancers. Immune biomarkers and PD-L1 expression warrant individualized treatments in synchronous primary adenocarcinoma and pulmonary sarcomatoid carcinoma. We describe the case of a patient with pulmonary sarcomatoid carcinoma and lung adenocarcinoma, metastatic to brain de novo. The patient achieved a complete response after only three cycles of carboplatin, paclitaxel, bevacizumab, and atezolizumab and remains free of any evidence of disease after 18 mo of maintenance therapy.

Received December 22, 2022. Accepted February 9, 2023.