Exploration of Immunotherapy in Advanced Pulmonary Lymphoepithelioma-Like Carcinoma
Menée à partir de données portant sur 96 patients atteints d'un carcinome pulmonaire de type lympho-épithéliome de stade avancé, cette étude rétrospective évalue l'efficacité, du point de vue de la survie sans progression, d'une immunothérapie, avec ou sans chimiothérapie à base de sels de platine, en traitement de première ligne ou en traitement de sauvetage
Pulmonary lymphoepithelioma-like carcinoma (PLELC) is a rare and histologically distinctive subtype of non-small cell lung cancer (NSCLC). High expression of Programmed Death Ligand1 (PD-L1) and scarcity of druggable driver mutations raise the potential of immunotherapy for advanced PELEC. However, evidence on the clinical impact of immune-checkpoint inhibitors (ICIs) remained limited and unconvincing. The present study retrospectively enrolled advanced PLELC patients who received ICIs either as up-front or salvage therapy in SYSUCC between March 15, 2017 and March 15, 2022. The comparative efficacy of chemoimmunotherapy versus chemotherapy in the first-line setting and chemoimmunotherapy versus ICIs monotherapy in the ≥2 line setting was investigated. A total of 96 patients were finally enrolled; 49 PLELC patients received immunotherapy plus platinum-based chemotherapy, while 45 patients received platinum-based chemotherapy as first-line treatment. Patients with chemoimmunotherapy significantly obtain more survival benefits than those receiving chemotherapy [median progression-free survival (PFS): 15.6 VS. 8.6 months(m), P=0.0015]. Additionally, patients with chemoimmunotherapy obtained more PFS benefits than those with ICIs monotherapy in the ≥2 line of therapy (median PFS: 21.7m VS. 7.8m, P=0.094). A significant correlation was observed between prognostic nutritional index (PNI) and favorable treatment outcomes in patients receiving first-line chemoimmunotherapy (median PFS: 17.8m VS. 7.6m, P<0.0001). Likewise, patients in the monocyte-to-lymphocyte ratio (MLR)-high group had significantly shorter PFS than the MLR-low group (median PFS: 11.2m VS. not reached, P=0.0009). This study elucidated the superior efficacy of ICIs therapy, especially chemoimmunotherapy in advanced PLELC, which may provide new insight into the role of immunotherapy in advanced PLELC.