Albumin Paclitaxel Plus Platinum With or Without Pembrolizumab for Metastatic Primary Pulmonary Lymphoepithelioma-like Carcinoma: a Retrospective Multicenter Study

Abstract

Objectives Primary pulmonary lymphoepithelioma-like carcinoma (PPLELC) is a rare subtype of primary non-small cell lung cancer (NSCLC), and the first-line therapy for metastatic PPLELC patients remains controversial. The purpose of this study was to investigate the efficacy and safety of immune checkpoint inhibitors(ICIs) combined with chemotherapy(CT) compared with traditional chemotherapy in these patients. Methods A total of 168 patients with metastatic PPLELC came from six grade A hospitals from August 2018 to August 2020 were selected. 17 patients were enrolled in the ICI group and received 200mg of Pembrolizumab plus albumin paclitaxel and carboplatin every 3 weeks. 34 patients with chemotherapy alone were assigned to the CT group and received albumin-paclitaxel combined with carboplatin every 3 weeks. Results As of June 1, 2021, the median PFS was 14.9 months for ICI group and 6.4 months for CT group [Hazard Ratio (HR), 0.29; 95% confidence interval (CI), 0.15-0.55; P < 0.05]. ORR was 64.7% in ICI group and 35.3% in CT group [HR, 0.65; 95%CI, 0.39-0.90; P=0.047]. The median OS of ICI group was not reached, while that of CT group was 13 months. In the ICI group, there were 8 cases (47.1%) of grade 3 treatment-related adverse reactions and 5 cases (29.4%) of grade 4 treatment-related adverse reactions. In the CT group, there were 9 cases (26.5%) of grade 3 treatment-related adverse reactions and 8 cases (23.5%) grade 4 treatment-related adverse reactions. FBXW7 mutation were negatively and TP53 mutation, MRE11A p.V198S mutation, PTEN p.T319FS mutation were positively correlated with the efficacy of immunotherapy. Conclusions In patients with metastatic PPLELC, the efficacy of immune checkpoint inhibitors combined with chemotherapy was significantly better than that of chemotherapy alone, and adverse reactions were acceptable.