Complete response to sotorasib as neoadjuvant treatment in patient with locally advanced primary pulmonary sarcoma harboring KRAS mutation: a case report

Background: Primary pulmonary sarcoma (PPS) is very rare relative to other subtypes of lung cancer. Therefore, evidence-based treatment options for PPS patients have remained unclear. Identification of actionable cancer driver mutations in patients with non-small cell lung cancer (NSCLC) has provided the chance to use targeted treatments and improve patient clinical outcomes. In addition to epidermal growth factor receptor (EGFR), the wide use of high-throughput genomic profiling with next-generation sequencing (NGS) has also identified other cancer driver genes such as Kirsten rat sarcoma (KRAS), human epidermal growth factor receptor 2 (HER2), and mesenchymal epithelial transition (MET). Case Description: In our study, we reported a locally advanced PPS patient harboring KRAS G12C mutation. The clinical stage before neoadjuvant treatment was stage IIIB (c.T3N2M0). The direct KRAS G12C inhibitor sotorasib (AMG-510) was used as neoadjuvant treatment and the patient achieved complete response (CR). Then, the patient underwent video-assisted thoracoscopic surgery (VATS) with reserved spontaneous breathing for surgical resection. The pathological evaluation was indicative of pathological CR (pCR). Further follow-ups are required to evaluate the long-term clinical benefit of neoadjuvant treatment with sotorasib and surgical resection with VATS. Conclusions: To our knowledge, it was the first study to use sotorasib for a PPS patient harboring KRAS G12C mutation in a neoadjuvant setting. Further follow-ups are required to evaluate the long-term clinical benefit of neoadjuvant treatment with sotorasib and surgical resection with VATS.