Journal
LUNG CANCER
Volume 137, Issue -, Pages 100-107Publisher
ELSEVIER IRELAND LTD
DOI: 10.1016/j.lungcan.2019.09.007
Keywords
Lung cancer; Pulmonary lymphoepithelioma-like carcinoma; Chemotherapy; Radiotherapy; Nasopharyngeal carcinoma; Epstein-Barr virus
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Funding
- National Key R&D Program of China [2016YFC0905500, 2016YFC0905503]
- National Natural Science Funds of China [81972898, 81602005, 81702283, 81872499, 81602011]
- Outstanding Young Talents Program of Sun Yat-sen University Cancer Center [16zxyc04]
- Central Basic Scientific Research Fund for Colleges-Young Teacher Training Program of Sun Yat-sen University [17ykpy81]
- Science and Technology Program of Guangdong Province [2017B020227001]
- Sun Yat-sen University Cancer Center Promotion Program for Talent Youth of National Natural Science Funds of China
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Objectives: Pulmonary lymphoepithelioma-like carcinoma (LELC) is a rare subtype of primary lung cancer. Due to the lack of prospective studies, the optimal first-line chemotherapy regimens and survival outcomes remain unclear. Materials and methods: This real-world, retrospective study enrolled consecutive patients with unresectable pulmonary LELC. The survival outcomes, prognosis, and comparative efficacy of different chemotherapy regimens were investigated. Results: In total, 127 patients were included in the analyses. The first-line chemotherapy regimens included gemcitabine plus platinum (GP, n = 19 [15.0%]), taxanes plus platinum (TP, n = 70 [55.1%]) and pemetrexed plus platinum (AP, n = 38 [30.0%]). 25 (19.7%) patients underwent palliative thoracic radiotherapy. 60 (47.2%) patients had detectable baseline Epstein-Barr virus (EBV) DNA. For the entire cohort, objective response was obtained in 41 patients (32.3%). Median progression-free survival (PFS) and overall survival (OS) were 7.7 months (95% CI, 6.6-8.8) and 36.7 months (95% CI, 30.9-42.5), respectively. Among the three chemotherapy regimens, GP achieved the highest response rate (GP, 63.2% vs. TP, 30.0% vs. AP, 21.1%; p = 0.005). Median PFS in the GP group (8.8 months) was also significantly longer than that in the TP group (7.9 months) and AP group (6.4 months) (p = 0.031). In the multivariate model, cycles of first-line chemotherapy (p < 0.001), palliative thoracic radiotherapy (p < 0.001), and chemotherapy regimens (p = 0.031) remained independent prognostic factors for PFS; while cycles of first-line chemotherapy (p = 0.002), baseline EBV DNA (p = 0.033) and palliative thoracic radiotherapy (p = 0.041) were significantly associated with OS. Conclusion: Gemcitabine-based chemotherapy and palliative thoracic radiotherapy are active in pulmonary LELC. These data provide added evidence for the similarity between pulmonary LELC and nasopharyngeal carcinoma in endemic area. Randomized controlled studies are needed to further define the standard-of-care for patients with advanced pulmonary LELC.
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