Neoadjuvant immunochemotherapy-a promising strategy for primary pulmonary lymphoepithelioma-like carcinoma.

Objective: Neoadjuvant immunochemotherapy has been a promising choice for patients with locally advanced non-small cell cancer (NSCLC). However, whether neoadjuvant immunochemotherapy impacted the subsequent surgical or pathological outcomes of patients with pulmonary lymphoepithelioma-like carcinoma (PLELC) remains relatively unknown. This study aimed to evaluate the safety and efficacy of neoadjuvant immunochemotherapy in PLELC patients.

Methods: A retrospective study was conducted on patients who received neoadjuvant immunochemotherapy in combination with chemotherapy followed by surgery between 2019 and 2022. The clinical records of the patients were analyzed.

Results: Among the 31 patients with PLELC who underwent neoadjuvant immunochemotherapy followed by surgery, 18 patients (58.0%) experienced tumor downstaging. Nineteen patients (61.5%) achieved a partial response, 2 patients (6.4%) achieved a complete response, and 2 (6.4%) exhibited progressive disease. Pathological evaluation of resected specimens revealed that 8 (25.8%) patients achieved major pathological response (MPR), and 2 (6.4%) pathological complete response (PCR). The mean disease-free survival (DFS) was 17.4 months, which was not significantly different from the value in lung squamous cell carcinoma (LSQ) patients (15.1 months, P = 0.54)).

Conclusion: Neoadjuvant immunochemotherapy is a safe and effective approach to reduce the extent of tumor, render unresectable to resectable, and offer an opportunity to receive modified surgery, which may be a promising strategy for patients with PLELC.