Ran-ran Li Xi-liang Di ^* Yuan Li ^* Hao Li ^* CHonghua Liu ^*

• Department of Oncology, Linyi People’s Hospital, Linyi, China

Pulmonary sarcomatoid carcinoma (PSC) is a scarce pathologic type of lung cancer of Non-small Cell Lung Cancer (NSCLC) that exhibits resistance to conventional chemotherapy and radiotherapy, resulting in a poor prognosis. Herein, a 67-year-old male was admitted to the hospital in January 2022 with a diagnosis of PSC for over 6 months and newly-discovered brain metastasis for 4 days. He had previously undergone two unsuccessful chemotherapy regimens: bevacizumab combined with pemetrexed and loplatin, and albumin-bound paclitaxel combined with loplatin.Radiotherapy was performed for brain metastases and skull metastases, followed by tislelizumab combined with anlotinib treatment, a PD-1 inhibitor with antiangiogenic drug. The patient initially received 9 cycles of treatment with tislelizumab and anlotinib, resulting in significant shrinkage of the lung tumor. Subsequently, anlotinib was discontinued due to bleeding in the brain metastases, and the patient received 2 additional cycles of tislelizumab. Following improvement in the hemorrhage from brain metastases, the patient received two cycles of treatment with tislelizumab and anlotinib.Treatment was subsequently interrupted for one month due to the COVID-19 pandemic, and then resumed with two additional cycles of tislelizumab and anlotinib. Finally, the patient refused to continue treatment due to the progression of brain metastases and economic conditions, despite the stable condition. At this point, the patient has achieved over a year of progression-free survival, with overall survival exceeding 39 months. This case illustrates the efficacy and safety of combining anti-tumor immunotherapy with anlotinib, a targeted anti-angiogenic therapy.