SMARCA4‐deficient undifferentiated tumor (SMARCA4‐UT) in the chest is a high‐grade malignant tumor that grows rapidly and often carries a poor prognosis. Unfortunately, there are currently no effective treatment available until now. Here, we report a case of SMARCA4‐UT in a patient who showed a swift response to a combination treatment of penpulimab, anlotinib, and chemotherapy. A 55‐year‐old man was diagnosed with thoracic SMARCA4‐UT along with metastases to multiple lymph nodes, the pleura, and bones. Immunohistochemical (IHC) testing indicated the absence of PD‐L1 expression in tumor cells. He was given sintilimab and anlotinib as first line treatment. However, a follow‐up chest CT revealed progressive disease (PD) after the first cycle treatment. Subsequently, the second line regimen was modified to etoposide and cisplatin (EP) combined with anlotinib and penpulimab. The effectiveness evaluation revealed partial remission (PR) following two cycles of the second‐line regimen treatment. Notably, the patient's progress‐free survival (PFS) exceeds 7 months and the overall survival up to 12 months. Our case implies that a combination of chemotherapy, anlotinib, and penpulimab might offer a promising therapeutic approach for PD‐L1‐negative thoracic SMARCA4‐UT.

Rationale Malignant Peripheral Nerve Sheath Tumor (MPNST) is an aggressive soft tissue sarcoma with limited therapeutic options and a poor prognosis. Its occurrence is closely related to genetic factors, and it is associated with Neurofibromatosis type I (NF1) in about 50% of cases. The overall incidence ranges from 3% to 10%, and it has been on the rise in recent years. Methods Retrospectively analyze the age of onset, tumor site, tumor size, metastasis, treatment plan, and prognosis of MPNST patients admitted to The First Affiliated Hospital of Henan Medical University from January 2018 to January 2022. Results In the past 5 years, 5 patients with MPNST aged 20–64 years were admitted to our center, including 2 males and 3 females. As of our writing of this manuscript: Of the 4 patients who underwent surgery, Case 1 patient died due to severe complications with overall survival of 11 months, Cases 2 and 4 patients are still alive with overall survival of 68 and 42 months, respectively, Case 5 patient with combined NF1 with overall survival of 18 months, and the patient in Case 3 patient was found to be inoperable due to the evaluation of condition at the time of discovery, but survived after systemic treatment with an overall survival of 45 months. All surviving patients continue to be followed up. Conclusion We described the clinical features, treatment, and clinical outcomes of 5 cases of MPNST, including one case of MPNST with NF1 gene mutation. This provides valuable clinical experience for the treatment of this rare tumor.

Evidence indicates that the long noncoding RNAs are involved in the metformin-mediated anti-cancer processes. However, the potential effects of the long noncoding RNAs in metformin-mediated anti-tumor processes in esophageal squamous cell carcinomas (ESCC) are still elusive. This study uncovered that metformin decreases the level of long noncoding RNAs CCAT1 and SPRY4-IT1 thereby contributing to the down-regulation of c-Myc and vimentin. Also, the RNA level test of human ESCC tissue confirmed the positive correlation between CCAT1 and c-Myc. These findings demonstrated that metformin facilitated anti-cancer effects by targeting the 2 long noncoding RNAs (CCAT1 and SPRY4-IT1) and their consequential targets c-Myc and vimentin. Therefore, the CCAT1 and SPRY4-IT1 might act as novel molecular targets that mediate the anti-tumor effects in esophageal squamous cell carcinoma. This helps in predicting the treatment response of metformin in patients diagnosed with esophageal squamous cell carcinoma.

Platinum-refractory ovarian cancer (PROC) is extremely malignant and aggressive. Patients typically have a diminished quality of life and limited survival, with an overall survival (OS) of less than one year. Until early 2024, bevacizumab remains the only targeted agent approved in China for the treatment of PROC. The standard regimen for PROC in China is non-platinum single-agent chemotherapy, or chemotherapy combined with bevacizumab. However, these therapies have not achieved satisfactory clinical outcomes. A 63-year-old woman presented with an incidentally detected left neck mass. Ultrasound-guided biopsy revealed high-grade serous ovarian carcinoma. She received first-line bevacizumab plus platinum-based chemotherapy but showed disease progression after two cycles, consistent with platinum-refractory ovarian cancer. After similarly failing second-line gemcitabine therapy (2 cycles), she achieved complete response (CR) and maintained progression-free survival (PFS) for 23.9 months with third-line etoposide combined with anlotinib and sintilimab. This case demonstrates that the combination of etoposide, anlotinib, and sintilimab can induce sustained CR in platinum-refractory ovarian cancer, achieving remarkable 23.9-month PFS. The synergistic activity of this regimen successfully reversed multidrug resistance and may redefine third-line therapeutic strategies for this challenging population.