YO13 - Pembrolizumb successfully treated refractory Epstein-Barr virus-associated lymphoepithelial carcinoma of lung

Date 18 December 2016
Event ESMO Asia 2016 Congress
Session Poster lunch
Topics Immunotherapy
Thoracic malignancies
Presenter Hsueh-Ju Lu
Authors H. Lu1, C. Chen2, W. Lin3, M. Wu1
  • 1Division Of Medical Oncology, Department Of Internal Medicine, Chung Shan Medical University Hospital Da-Ching, 402 - Taichung/TW
  • 2Division Of Chest Surgeon, Department Of Surgery, Chung Shan Medical University Hospital Da-Ching, 402 - Taichung/TW
  • 3Department Of Pathology, Chung Shan Medical University Hospital Da-Ching, 402 - Taichung/TW


Case Summary

Pembrolizumab, an IgG4-κ monoclonal PD-1 antibody, showed successfully effective in many cancer types gradually. But limited information showed this novel agent was useful for rare malignancies, especially for Epstein-Barr virus-associated cancers. Lymphoepithelial carcinoma (LEC) of lung, a rare pathologic type of primary lung tumor, is defined as a poorly differentiated squamous cell carcinoma or undifferentiated carcinoma accompanied by a prominent reactive lymphoplasmacytic infiltrate. The pathologic features of LEC are similar to nasopharyngeal carcinoma (NPC). We presented a 49-year-old woman diagnosed LEC of lung, pT3N1M0, stage IIIA, with Epstein-Barr-encoded RNA(EBER) positive. After the definitive surgical resection followed up adjuvant chemotherapy, the disease progressed to stage IV in the tenth month from initial resection because of pleural metastasis. Although multiple lines of chemotherapy, including EGFR TKI, were treated for her as lung cancer, the disease was still progressive to multiple huge mediastinal lymph nodes. These lymph nodes compressed to the major vessels and esophagus, and also caused postprandial vomiting. Therefore, pembrolizumab was used with a dose of 2mg per kilogram of body weight every 3 weeks. After 3 cycles of pembrolizumab, the symptom of postprandial vomiting began improving; then through 6 cycles, repeated chest CT showed the sizes of bulky mediastinal lymph nodes were marked regression. Serum EBV DNA virus load was dramatically decreased from 817,725 copies/μg to 3848 copies/μg. There was no adverse event expect grade 1 pruritus. From this exciting experience, we may anticipate that pembrolizumab can be effective in Epstein-Barr virus-associated malignancies. The prospective large studies are suggested to confirm the efficacy and long-term outcomes.