Neoadjuvant Therapy Before Resection of Primary Pulmonary Lymphoepithelial Carcinoma

IF 3.3 3区 医学 Q2 ONCOLOGY Clinical lung cancer Pub Date : 2024-01-29 DOI:10.1016/j.cllc.2024.01.007
Erik Wu , Joseph Reznicek , Anjana V. Yeldandi , Jyoti D. Patel , David D. Odell
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Abstract

  • Primary pulmonary lymphoepithelial carcinoma (LEC) is an extremely rare form of lung cancer that is most often associated with Epstein Barr virus and affects a different patient population than other lung cancer subtypes.

  • There is no consensus on treatment strategy for primary pulmonary LEC due to its rarity, and most locally advanced disease is managed with resection followed by adjuvant chemotherapy.

  • This case marks the first documented occurrence of primary pulmonary LEC treated with neoadjuvant chemotherapy and PD1 checkpoint immunotherapy, demonstrating significant radiological response, followed by successful complete resection.

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原发性肺淋巴上皮癌切除术前的新辅助疗法
原发性肺淋巴上皮癌(LEC)是非小细胞肺癌(NSCLC)中极为罕见的一种,自 1987 年发现以来,记录在案的病例不足 500 例。这些病例绝大多数发生在东亚或东南亚,与爱泼斯坦-巴氏病毒(EBV)有关。虽然局部疾病可通过手术切除或切除后辅助化疗来治疗,但目前尚未就明确的治疗策略达成共识。一名 64 岁的患者于 35 年前从越南移民而来,出现间歇性咳嗽,胸部计算机断层扫描发现其左下叶肿块。正电子发射断层扫描显示,该肿块为高代谢性,纵隔和肺周淋巴结可能有活动,提示为 cT4N2M0 或 IIIB 期疾病。在支气管内超声下进行的经支气管针活检的免疫组化结果显示,EBV相关LEC分化较差。此外,还发现90%的肿瘤细胞有程序性死亡配体1(PDL1)阳性表达。患者开始接受顺铂/多西他赛和 nivolumab 的新辅助免疫化疗,并完成了 3 个周期的治疗后进行了复查。经过3个周期的新辅助治疗后,患者的原发性肺LEC肿块缩小了40%。患者接受了左下肺叶切除术,并进行了淋巴结取样。病理结果显示,患者病情明显降低至ypT1N0,术后情况良好。在这里,新辅助化疗加检查点免疫疗法被证明是一种可行的替代疗法,可替代之前尝试的肺癌LEC治疗策略,扩大了有效治疗的选择范围。此外,其他讨论还详细介绍了目前肺癌切除术的研究现状。
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来源期刊
Clinical lung cancer
Clinical lung cancer 医学-肿瘤学
CiteScore
7.00
自引率
2.80%
发文量
159
审稿时长
24 days
期刊介绍: Clinical Lung Cancer is a peer-reviewed bimonthly journal that publishes original articles describing various aspects of clinical and translational research of lung cancer. Clinical Lung Cancer is devoted to articles on detection, diagnosis, prevention, and treatment of lung cancer. The main emphasis is on recent scientific developments in all areas related to lung cancer. Specific areas of interest include clinical research and mechanistic approaches; drug sensitivity and resistance; gene and antisense therapy; pathology, markers, and prognostic indicators; chemoprevention strategies; multimodality therapy; and integration of various approaches.
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