Large cell neuroendocrine carcinoma of the lungs: case report and literature review.

Pulmonary large cell neuroendocrine carcinoma (LCNEC) is a rare but destructive tumor type, accounting for approximately 1% of all lung cancers, associated with poor prognosis. LCNEC is challenging diagnosing using biopsy specimens. While current LCNEC therapies include surgery, radiotherapy, and chemotherapy, it has not yet proved its greatest treatment strategies. Immunotherapy is rapidly emerging as a possibility for lung cancer treatment. However, there are scant reports in the literature regarding LCNEC immunotherapy. Therefore, the author here reports a case of LCNEC by immunotherapy, and retrospective reviews the present research status and progress of LENCE and corresponding clinical treatment progress. This case will supply valuable information for the treatment options for LCNEC. A 64-year-old male smoker was treated for one month for blood in his sputum. Chest radiography and computed tomography revealed a 3-cm solitary tumor in the left upper lung. We treated the patient with thoracoscopic radical surgery for upper left lung cancer. Postoperative pathology shows pulmonary LCNEC. We performed postoperative chemotherapy with a double-drug regimen holding platinum. Then, bevacizumab, paclitaxel, and the PD-L1 checkpoint inhibitor nivolumab were applied, but the patient progressed rapidly. Immunotherapy is an ineffective treatment possibility for these patients, even if PD-L1 expression is positive. A possible contributing factor is the timing of immunotherapy too late.