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Adenosquamous carcinoma is an uncommon lung cancer that contains both gland-forming and squamous cancer cells, each making up at least a tenth of the tumour. It behaves worse than either pure type, but its gland-forming part often carries an EGFR mutation, so it is tested and treated like adenocarcinoma.
The WHO classification defines adenosquamous carcinoma as a carcinoma with at least 10 percent each of adenocarcinoma and squamous cell carcinoma, a diagnosis that can be made reliably only on a resection specimen; small biopsies usually capture one component (Li 2018). In the Japanese multi-institutional cohort adenosquamous cases had worse survival curves than adenocarcinoma or squamous cell carcinoma for all stages and for stage IA, IB and IIIA (Maeda 2012).
How it differs from its parent: it is the histology in which the treatment rules of adenocarcinoma and squamous cell carcinoma collide. The review evidence favours treating it as adenocarcinoma: EGFR mutations are frequent enough that EGFR inhibitors such as erlotinib and gefitinib are effective in EGFR-mutant advanced disease, platinum-based adjuvant chemotherapy for at least four cycles improved survival in stage III, data on ALK inhibitors are very limited, and checkpoint inhibitors are a potential option (Li 2018).
How common: 2.4 percent of resected lung cancers in the Japanese series (Maeda 2012); no population figure was found in the sources read.
Treatment: as the parent by stage, with driver testing as for adenocarcinoma and EGFR inhibitors when a mutation is found; pemetrexed-based regimens are generally used because of the glandular component (Li 2018).
2.4 percent of resected primary lung cancers (114 of 4,668 operations, Japan National Hospital Organization, 1997 to 2003), against 64.2 percent adenocarcinoma and 29.3 percent squamous cell carcinoma in the same series (Maeda 2012).
Central tumours arise in the large airways, peripheral ones in the alveoli; both drain to hilar then mediastinal nodes, and the pleural lining is a separate cancer site.
Same organ: Mediastinal germ cell tumour, Pleuropulmonary blastoma (types I, Ir, II and III), Type A and type AB thymoma, Type B1 and type B2 thymoma, Type B3 thymoma, Micronodular thymoma with lymphoid stroma, Adenocarcinoma of the lung, Squamous cell carcinoma of the lung, Large cell carcinoma of the lung, Sarcomatoid carcinoma of the lung, Invasive mucinous adenocarcinoma of the lung, Adenocarcinoma in situ and minimally invasive adenocarcinoma of the lung, Basaloid squamous cell carcinoma of the lung, Lymphoepithelial carcinoma of the lung, Pulmonary blastoma (adult), Non-small-cell lung cancer, Lung cancer (all types), Small-cell lung cancer, Mesothelioma, Pleural mesothelioma, Thymoma and thymic carcinoma, Childhood lung and airway tumours (pleuropulmonary blastoma, tracheobronchial tumours), Inflammatory myofibroblastic tumour (IMT), EGFR-mutated non-small-cell lung cancer, ALK-positive non-small-cell lung cancer, KRAS G12C-mutant non-small-cell lung cancer, ROS1-positive non-small-cell lung cancer, MET exon 14 and MET-amplified non-small-cell lung cancer, RET fusion-positive non-small-cell lung cancer, BRAF V600E-mutant non-small-cell lung cancer, HER2-mutant non-small-cell lung cancer, NTRK fusion-positive non-small-cell lung cancer, PD-L1-high non-small-cell lung cancer without a driver mutation, Resectable stage I to III non-small-cell lung cancer, Unresectable stage III non-small-cell lung cancer, Limited-stage small-cell lung cancer, Extensive-stage small-cell lung cancer, Lung neuroendocrine tumours (typical and atypical carcinoid), Thymoma (WHO types A, AB, B1, B2 and B3), Thymic carcinoma
Treated as lung adenocarcinoma: driver testing, EGFR inhibitors when mutated, platinum-based chemotherapy with immunotherapy otherwise.
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Query for this cancer: (TITLE:"Adenosquamous carcinoma of the lung" OR ABSTRACT:"Adenosquamous carcinoma of the lung" OR TITLE:"Adenosquamous cell lung cancer" OR ABSTRACT:"Adenosquamous cell lung cancer" OR TITLE:"Mixed adenocarcinoma and squamous cell carcinoma of the lung" OR ABSTRACT:"Mixed adenocarcinoma and squamous cell carcinoma of the lung") AND (treatment OR therapy OR trial OR survival OR diagnosis). Results are unfiltered search hits about Adenosquamous carcinoma of the lung, not a curated reading list.
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Fainting, near-fainting, or an irregular or racing heartbeat; several kinase inhibitors prolong the QT interval and the labels require ECG and electrolyte monitoring.
Bleeding that will not stop, black or bloody stools, or unexplained bruising when platelets are expected to be low.
Take on an empty stomach (1 hour before or 2 hours after food); food raises exposure. Smoking induces CYP1A2 and lowers exposure.
Not recommended for CrCl below 45.
Use with caution; interrupt or discontinue if bilirubin doubles or transaminases triple.
Monitor liver function; discontinue for severe changes.
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