First-line Platinum-based Chemotherapy and Survival Outcomes in Locally Advanced or Metastatic Pulmonary Lymphoepithelioma-like Carcinoma
Menée dans un contexte de vie réelle à partir de données portant sur 127 patients atteints d'un carcinome pulmonaire de type lympho-épithéliome, cette étude rétrospective compare l'efficacité, du point de vue du taux de réponse objective, de la survie sans progression et de la survie globale, de plusieurs stratégies de chimiothérapies de première ligne à base de sels de platine et d'un autre agent (gemcitabine, taxanes, pémétrexed)
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 salvage thoracic radiotherapy. 60 (47.2%) patients had detectable baseline 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), salvage 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 Epstein-Barr virus DNA (p = 0.033) and thoracic radiotherapy (p = 0.041) were significantly associated with OS. Conclusion : Gemcitabine-based chemotherapy and salvage 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.