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

Abstract 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 an...

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Main Authors: Fu-Lian Qu, Yao-Hong Gao, Yan Zhang, Hong-Rui Zhang, Ya-Zhen Hong, Xiao-Jing Tie, Pei-Jie Liu
Format: Article
Language:English
Published: BMC 2025-07-01
Series:Journal of Cardiothoracic Surgery
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Online Access:https://doi.org/10.1186/s13019-025-03534-3
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author Fu-Lian Qu
Yao-Hong Gao
Yan Zhang
Hong-Rui Zhang
Ya-Zhen Hong
Xiao-Jing Tie
Pei-Jie Liu
author_facet Fu-Lian Qu
Yao-Hong Gao
Yan Zhang
Hong-Rui Zhang
Ya-Zhen Hong
Xiao-Jing Tie
Pei-Jie Liu
author_sort Fu-Lian Qu
collection DOAJ
description Abstract 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.
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spelling doaj-art-e03e3b2e23544b7fb2fb7248322c077a2025-08-20T04:03:02ZengBMCJournal of Cardiothoracic Surgery1749-80902025-07-012011910.1186/s13019-025-03534-3Comparative analysis of antiangiogenic and immunotherapeutic regimens in the treatment of metastatic pulmonary lymphoepithelioma-like carcinomaFu-Lian Qu0Yao-Hong Gao1Yan Zhang2Hong-Rui Zhang3Ya-Zhen Hong4Xiao-Jing Tie5Pei-Jie Liu6Department of Medical Oncology, Kai Feng Central HospitalDepartment of Medical Oncology, Kai Feng Central HospitalDepartment of Medical Oncology, Kai Feng Central HospitalDepartment of Medical Oncology, Kai Feng Central HospitalDepartment of Medical Oncology, Kai Feng Central HospitalDepartment of Medical Oncology, Kai Feng Central HospitalDepartment of Medical Oncology, Kai Feng Central HospitalAbstract 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.https://doi.org/10.1186/s13019-025-03534-3Anti-tumor angiogenesis drugsCytotoxic drugsEpstein-Barr virus (EBV)Immune checkpoint inhibitors (ICIs)Pulmonary lymphoepithelioma-like carcinoma (PLELC)
spellingShingle Fu-Lian Qu
Yao-Hong Gao
Yan Zhang
Hong-Rui Zhang
Ya-Zhen Hong
Xiao-Jing Tie
Pei-Jie Liu
Comparative analysis of antiangiogenic and immunotherapeutic regimens in the treatment of metastatic pulmonary lymphoepithelioma-like carcinoma
Journal of Cardiothoracic Surgery
Anti-tumor angiogenesis drugs
Cytotoxic drugs
Epstein-Barr virus (EBV)
Immune checkpoint inhibitors (ICIs)
Pulmonary lymphoepithelioma-like carcinoma (PLELC)
title Comparative analysis of antiangiogenic and immunotherapeutic regimens in the treatment of metastatic pulmonary lymphoepithelioma-like carcinoma
title_full Comparative analysis of antiangiogenic and immunotherapeutic regimens in the treatment of metastatic pulmonary lymphoepithelioma-like carcinoma
title_fullStr Comparative analysis of antiangiogenic and immunotherapeutic regimens in the treatment of metastatic pulmonary lymphoepithelioma-like carcinoma
title_full_unstemmed Comparative analysis of antiangiogenic and immunotherapeutic regimens in the treatment of metastatic pulmonary lymphoepithelioma-like carcinoma
title_short Comparative analysis of antiangiogenic and immunotherapeutic regimens in the treatment of metastatic pulmonary lymphoepithelioma-like carcinoma
title_sort comparative analysis of antiangiogenic and immunotherapeutic regimens in the treatment of metastatic pulmonary lymphoepithelioma like carcinoma
topic Anti-tumor angiogenesis drugs
Cytotoxic drugs
Epstein-Barr virus (EBV)
Immune checkpoint inhibitors (ICIs)
Pulmonary lymphoepithelioma-like carcinoma (PLELC)
url https://doi.org/10.1186/s13019-025-03534-3
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