First-line platinum-based chemotherapy and survival outcomes in locally advanced or metastatic pulmonary lymphoepithelioma-like carcinoma. (November 2019)

• Record Type: Journal Article
• Authors: Lin, Zuan; Fu, Sha; Zhou, Yixin; Zhang, Xuanye; Chen, Chen; He, Li-na; Li, Haifeng; Wang, Yuhong; Chen, Tao; Zhang, Li; Hong, Shaodong
• Is Part Of: Lung cancer. Volume 137(2019)
• Page Start: 100
• Page End: 107
• Publication Date: 2019-11
• Subjects: LELE lymphoepithelioma-like carcinoma -- NPC nasopharyngeal carcinoma -- NSCLC non-small cell lung cancer -- EBV Epstein-Barr virus -- RECIST Response Evaluation Criteria in Solid Tumors -- ORR objective response rate -- PR partial response -- CR complete response -- DCR disease control rate -- SD stable disease -- PFS progression-free survival -- PD progressive disease -- OS overall survival -- CIs confidence intervals -- ECOG Eastern Cooperative Oncology Group -- PS performance status -- CNS central nervous system -- GP gemcitabine plus platinum -- TP taxanes plus platinum -- AP pemetrexed plus platinum -- NOS not otherwise specific -- CNASCA China National Accreditation Service for Conformity Assessment -- ISH in situ hybridization; Lung cancer -- Pulmonary lymphoepithelioma-like carcinoma -- Chemotherapy -- Radiotherapy -- Nasopharyngeal carcinoma -- Epstein-Barr virus; Lungs -- Cancer -- Periodicals; Lung Neoplasms -- Abstracts; Lung Neoplasms -- Periodicals; Poumons -- Cancer -- Périodiques; Lungs -- Cancer; Periodicals; Electronic journals; Electronic journals; 616.99424
• DOI: 10.1016/j.lungcan.2019.09.007
• Languages: English
• ISSNs: 0169-5002

Abstract

Highlights: We report data from the largest cohort of advanced pulmonary LELC patients. Palliative thoracic radiotherapy extends the survival of advanced pulmonary LELC. Gemcitabine-based chemotherapy is active in pulmonary LELC. We revealed key prognostic factors, including EBV DNA and cyles of chemotherapy. Abstract: 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.