Diagnosis and treatment of pulmonary lymphoepithelioma-like carcinoma: A case report.

Background: Pulmonary lymphoepithelioma-like carcinoma (PLELC) is a rare primary epithelial lung cancer associated with the Epstein-Barr virus. Standard treatment guideline for PLELC is yet not to be established, surgery remains the primary treatment for early-stage PLELC, and platinum chemotherapy is the most common first-line treatment for advanced PLELC. While targeted therapy and immunotherapy has emerged as effective way to treat various malignant tumors, including lung cancer, reports on PLELC are relatively scarce.

Case summary: A 38-year-old man was diagnosed with right PLELC. Chest computed tomography (CT) revealed a mass in the medial segment of the middle lobe of the right lung, with lymph node metastasis in the mediastinum and right hilum of the lung. CT-guided lung tumor biopsy was performed and the postoperative pathological examination combined with immune phenotype analysis and in situ hybridization confirmed PLELC. Standard molecular testing for patients with non-small cell lung cancer was negative and programmed cell death ligand-1 expression was about 2%. The patient declined radiotherapy and chemotherapy. Consequently, immunotherapy was administered, which included toripalimab 240 mg on day 1 and anlotinib 10 mg on days 1-14 for 10 cycles, followed by a maintenance dose of anlotinib 10 mg daily every 3 weeks. As a result, his progression-free survival reached 48 months.

Conclusion: A combination of toripalimab and anlotinib may benefit patients with advanced diseases who have not received systematic antitumor therapy.