Kumar Vivek, Dave Vishangi, Harris Jonathan, Huang Yiwu
Department of Internal Medicine, Maimonides Medical Center, Brooklyn, NY 11219, USA.
Hematology & Oncology, Maimonides Medical Center, Brooklyn, NY 11219, USA.
Immunotherapy. 2017 Sep;9(12):955-961. doi: 10.2217/imt-2017-0067. Epub 2017 Sep 20.
Lymphoepithelioma-like carcinoma (LELC) of lung is a rare tumor that is mostly reported in south-east Asian countries. The surgical removal is curative in the early stages but there is no consensus on the choice of chemotherapy for the treatment of advanced stage tumors. Most of the data on chemotherapy are based on small case series and retrospective studies. As per available data, this tumor responds to chemotherapy initially but recurrences are common. The use of conventional chemotherapy in recurrent tumors leads to cumulative toxicities in the long term. Due to lack of actionable mutations, targeted therapies are also not very useful. Immune check point inhibitors immune checkpoint inhibitors have shown survival benefit in patients with advanced stage non-small-cell and small cell carcinoma with better side effect profile than conventional chemotherapy. The role of immune checkpoint inhibitors in LELC is unknown. Though several studies have reported high expression of programmed cell death-1 (PD-1)/or its -ligand (PD-L1) in LELC providing a rationale for trial of these agents, the actual benefit of these agents in LELC has not been reported so far. In this case series, we report two cases of advanced stage LELC that progressed despite multiple lines of chemotherapy but responded favorably to a PD-1 inhibitor, nivolumab.
肺淋巴上皮瘤样癌（LELC）是一种罕见肿瘤，多见于东南亚国家。早期手术切除可治愈，但对于晚期肿瘤的化疗选择尚无共识。大多数化疗数据基于小病例系列和回顾性研究。根据现有数据，该肿瘤最初对化疗有反应，但复发很常见。复发性肿瘤使用传统化疗长期会导致累积毒性。由于缺乏可操作的突变，靶向治疗也不太有用。免疫检查点抑制剂在晚期非小细胞癌和小细胞癌患者中已显示出生存获益，且副作用比传统化疗更好。免疫检查点抑制剂在LELC中的作用尚不清楚。尽管多项研究报告LELC中程序性细胞死亡蛋白1（PD-1）/或其配体（PD-L1）高表达，为试验这些药物提供了理论依据，但这些药物在LELC中的实际获益迄今尚未见报道。在本病例系列中，我们报告了2例晚期LELC病例，尽管接受了多线化疗仍进展，但对PD-1抑制剂纳武单抗反应良好。
