Comparative analysis of antiangiogenic and immunotherapeutic regimens in the treatment of metastatic pulmonary lymphoepithelioma-like carcinoma.

Background and objective: Pulmonary lymphoepithelioma-like carcinoma (PLELC) is a rare histological subtype of non-small cell lung cancer for which no standard treatment protocol exists in the metastatic setting. This study aims to evaluate the efficacy and safety of antiangiogenic agents and immune checkpoint inhibitors (ICIs), individually and in combination with cytotoxic chemotherapy, in patients diagnosed with metastatic PLELC. The findings aim to inform therapeutic strategies for this uncommon malignancy.

Method: A retrospective analysis of electronic medical records was performed to identify patients diagnosed with metastatic PLELC. Based on the treatment regimens received, participants were stratified into three groups: antiangiogenic agents plus ICIs (AI group), antiangiogenic agents plus ICIs and cytotoxic chemotherapy (AIC group), and antiangiogenic agents plus cytotoxic chemotherapy without ICIs (AC group).

Results: Nineteen patients were included in the analysis. The overall objective response rate (ORR) was 78.9% (15/19), the disease control rate (DCR) was 94.8% (18/19), and the median progression-free survival (mPFS) was 12.9 months. In the AIC group, the ORR was 72.7% (8/11), the DCR was 90.9% (10/11), and the mPFS was 16.0 months. In the AI group, the ORR was 83.3% (5/6), the DCR was 100% (6/6), and the mPFS was 12.35 months. In the AC group, both the ORR and DCR were 100% (2/2), with an mPFS of 6.45 months. Patients in the AIC group exhibited substantial tumor regression. Furthermore, those with programmed death-ligand 1 (PD-L1) expression ≥ 50% experienced significantly prolonged mPFS compared to patients with PD-L1 expression < 50%. Following disease progression, clinical conditions remained stable under subsequent antiangiogenic therapy.

Conclusion: The combination of antiangiogenic agents, ICIs, and cytotoxic chemotherapy demonstrated promising efficacy and an acceptable safety profile in the treatment of metastatic PLELC. These findings support further exploration of multi-modality regimens in this rare lung cancer subtype.