Zihan Wang, Jiashuo Wang, Shiqi Liu, Shi Zong, Xiwen Wang
In metastatic NSCLC, the addition of tremelimumab to durvalumab does not confer a statistically significant overall survival advantage in unselected populations and is associated with a marked increase in immune-mediated toxicities. Benefits may be restricted to biomarker-defined subgroups, but these findings remain exploratory. Further prospective studies are needed to clarify the optimal role of CTLA-4 blockade in combination immunotherapy.
Invasive mucinous adenocarcinoma (IMA) of the lung is an uncommon but clinically important subtype of lung adenocarcinoma with distinctive radiologic, histopathologic, and molecular features. Its indolent symptoms, mucin-rich growth pattern, and frequent pneumonia-like or multifocal presentation can obscure early diagnosis and complicate distinction from infection, synchronous primary tumors, and intrapulmonary spread. This review integrates current evidence on the clinical course, imaging phenotypes, diagnostic workflow, histopathologic features, molecular alterations, tumor immune microenvironment, and treatment response patterns of IMA. Emphasis is placed on the relationship between radiologic appearance and underlying mucinous pathology, the clinical significance of spread through air spaces (STAS), and the need for adequate tissue sampling and comprehensive molecular profiling. Compared with non-mucinous lung adenocarcinoma, IMA is enriched for KRAS mutations and selected fusion or receptor alterations, whereas canonical EGFR mutations are less frequent. These biological differences help explain why treatment strategies extrapolated from broader non-small cell lung cancer (NSCLC) populations may be insufficient, particularly for multifocal, pneumonic-type, or advanced disease. Although surgery can provide favorable outcomes in localized disease, systemic therapy remains challenging, and the role of immunotherapy requires further clarification. Future progress will depend on integrated imaging-pathology-genomic models, prospective IMA-specific cohorts, and translational studies aimed at refining classification and developing individualized therapeutic strategies.