Abstract
Pulmonary lymphoepithelioma-like carcinoma (pLELC) is a rare subtype of lung cancer that is associated with the Epstein-Barr virus in Asia. Due to the lack of prospective studies, the best first-line treatment and survival outcomes remain unclear. Herein, This study investigated the efficacy and safety of different treatment regimens for advanced pLELC. This retrospective study included 68 patients with advanced pLELC from two centers in China. Patients were divided into three groups according to different first-line treatments: chemotherapy (n=49, 72.1%), immunotherapy (n=7, 10.3%), and chemoimmunotherapy (n=12,17.6%). The primary endpoint of this study was the 2-year progression-free survival (PFS) of each group. The results show that the median PFS was 6.9 months (range, 2.3–not estimable) in the chemotherapy group, 11.0 months (range, 2–not estimable) in the immunotherapy group, and 11.8 months (range, 6–not estimable) in the chemoimmunotherapy group. There was a significant difference in 2-year PFS between the chemoimmunotherapy group and the chemotherapy group (hazard ratio, 0.38, 95% confidence interval: 0.18-0.78, log-rank P=0.007). The most frequent grade 3-4 adverse event in the chemotherapy and chemoimmunotherapy groups was myelosuppression (10/49 [22.4%] and 4/12 [33.3%], respectively). The most frequent grade 3-4 adverse events in the immunotherapy group were diarrhea (1/7, 14.8%) and hepatotoxicity (1/7, 14.8%). Chemoimmunotherapy had the highest 2-year PFS as a first-line treatment for advanced pLELC compared to chemotherapy and immunotherapy. This study suggests that chemoimmunotherapy may be the best first-line treatment for patients with advanced pLELC.
Highlights
Our results showed that the 2-year progression-free survival (PFS) with chemoimmunotherapy was significantly better than that of chemotherapy, with an median PFS (mPFS) that was 5 months longer than chemotherapy
In locally advanced Pulmonary lymphoepithelioma-like carcinoma (pLELC), the effect of chemoradiotherapy is better than chemotherapy alone [18, 25]
Previous studies have indicated that compared with other non-small cell lung cancer (NSCLC), the mutations of EGFR, ALK, and MET were extremely low in patients with pLELC, suggesting that familiar typical driver mutations may not play a critical role in pLELC [33, 34]
Summary
Pulmonary lymphoepithelioma-like carcinoma (pLELC) is a rare pathological subtype of lung cancer [1], which has been shown to be closely associated with Epstein-Barr virus (EBV) infection [2]. pLELC has unique clinicopathological features, such as predominance in younger non-smokers in Asia and heavy lymphocytic infiltration [1, 3, 4].Lung tumor cells frequently express high levels of programmed death ligand 1 (PD-L1), which is the ligand of the programmed death-1 (PD-1) receptor on T cells, allowing tumors to directly inhibit the host immune response by inhibiting the proliferation and function of T cells [5,6,7,8,9]. Pulmonary lymphoepithelioma-like carcinoma (pLELC) is a rare pathological subtype of lung cancer [1], which has been shown to be closely associated with Epstein-Barr virus (EBV) infection [2]. Nasopharyngeal carcinoma (NPC) is associated with EBV infection and has a high propensity for regional and distant metastases, while it is very sensitive to radiation and chemotherapy [14]. A common feature of advanced EBVpositive NPC is the dense infiltration of lymphocytes in the tumor stroma and positive PD-L1 expression in tumor cells, making it an attractive target for immunotherapy [14]. Immunotherapy has shown promise in patients with advanced nasopharyngeal cancer [15, 16]
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