2023 North America Conference on Lung Cancer (NACLC) - Posters and Abstracts-PP01.17 (Poster) Neoadjuvant Therapy Before Resection of Primary Pulmonary Lymphoepithelioma-Like Carcinoma

PP01.17 (Poster) Neoadjuvant Therapy Before Resection of Primary Pulmonary Lymphoepithelioma-Like Carcinoma

Pdf Summary

A 64-year-old male patient with a history of immigrating from Vietnam 35 years ago and pre-existing conditions including T2DM, HTN, CAD, and minimal smoking history presented to a clinic with occasional cough and subjective fevers. A left lower lobe mass was noted on a chest CT scan and further evaluation with PET CT revealed metabolic activity in the mass and potential mediastinal lymph node activity, indicating stage IIIB disease. A transbronchial needle biopsy confirmed poorly differentiated Epstein-Barr virus (EBV)-associated primary pulmonary lymphoepithelioma-like carcinoma (ppLEC). The patient underwent neoadjuvant chemo-immunotherapy with cisplatin/docetaxel and nivolumab, which resulted in a 40% reduction in the size of the primary mass. Subsequently, the patient underwent left lower lobectomy with lymph node sampling and was diagnosed with stage 1A disease. Nine months post-operatively, there was no recurrence of the disease.<br /><br />Primary pulmonary lymphoepithelioma-like carcinoma is a rare subset of non-small cell lung cancer (NSCLC) associated with EBV. It primarily affects non-smokers and younger individuals and presents in earlier stages. The case highlights the use of neoadjuvant chemotherapy and checkpoint immunotherapy, specifically nivolumab, in the management of ppLEC. PDL1 inhibitors, such as nivolumab, have shown promise in the treatment of unresectable disease and may also be a viable option for locally advanced disease management. The case provides important insights into the diagnosis and management of uncommon conditions like ppLEC and expands the treatment options available for these patients. However, there is currently no consensus on the optimal management approach for ppLEC, and further research is needed to determine the best treatment strategies.

Asset Subtitle

Erik Wu

Keywords

64-year-old male

Vietnam immigrant

T2DM

HTN

CAD

smoking history

chest CT scan

stage IIIB disease

neoadjuvant chemo-immunotherapy

nivolumab