Large cell neuroendocrine carcinoma of the lung: chemotherapy regimen depends on how "large" your diagnostic criteria are. Issue 4 (26th October 2017)

• Record Type: Journal Article
• Authors: Rossi, Giulio; Longo, Lucia; Barbieri, Fausto; Bertolini, Federica; Spagnolo, Paolo
• Is Part Of: European respiratory journal. Volume 50:Issue 4(2017)
• Publication Date: 2017-10-26
• Subjects: Respiratory organs -- Diseases -- Periodicals; Respiration -- Periodicals; 616.2
• DOI: 10.1183/13993003.01292-2017
• Languages: English
• ISSNs: 0903-1936

Abstract

We read with great interest the article by Derks et al . [1] on the efficacy of different chemotherapeutic regimens in a large series of 128 patients with stage IV large cell neuroendocrine carcinoma (LCNEC) of the lung. As outlined by the authors, in 2005, we dealt with the same dilemma when analysing 83 surgically resected LCNECs collected at two different institutions [2]. In our study, patients with metastatic disease treated either in an adjuvant setting or post-surgery with platinum/etoposide, a conventional regimen for small cell lung cancer (SCLC), showed a significant clinical benefit in terms of overall survival compared to patients treated with chemotherapeutic regimens used for non-small cell lung cancer (NSCLC). In contrast, Derks et al . [1] showed that patients with metastatic LCNEC receiving platinum/gemcitabine, a regimen commonly used in NSCLC, displayed a longer overall survival than those receiving SCLC-oriented chemotherapy. In our view, a number of reasons, discussed herein, may account for the apparent discrepancies between these and other studies [3]. In our study [2], LCNEC cases eventually represented less than one-quarter (83 (23.8%) out of 348) of all lung cancer cases identified based on morphological examination alone. In addition, although we applied strict diagnostic criteria, some cases required a consensus diagnosis among all three thoracic pathologists involved in the histological review, highlighting the difficulties encountered when making a diagnosis of LCNEC, even amongst expert pathologists [4]. In agreement with the last two World Health Organization (WHO) classifications of lung tumours [5] suggesting to limit/avoid the diagnosis of LCNEC on cytology/small biopsy, we included only surgically resected cases ( i.e . none of our original cases was in stage IV at the time of the diagnosis). Conversely, Derks et al . [1] and another recent study by Naidoo et al. [6] included only stage IV LCNEC cases diagnosed on biopsy. Diagnostic criteria influence the correct chemotherapy in LCNEC http://ow.ly/MSPR30ePZNK