345P - First-line gemcitabine-platinum chemotherapy in relapsed or metastatic pulmonary lymphoepithelioma-like carcinoma: A tertiary centre experience

Background

Pulmonary lymphoepithelioma-like carcinoma (LELC) is a rare subtype of non-small cell lung cancer, endemic in southeast Asia. LELC has histologic resemblance to undifferentiated nasopharyngeal carcinoma, which is highly sensitive to gemcitabine-platinum chemotherapy. Evidence to support this treatment in LELC is however limited. This study aims to evaluate the efficacy of gemcitabine-cisplatin (GP) or gemcitabine-carboplatin (GC) in relapsed or metastatic pulmonary LELC.

Methods

Consecutive patients with relapsed or metastatic pulmonary LELC who received palliative systemic therapies in 2010 – 2019 in Department of Clinical Oncology, Queen Elizabeth Hospital, Hong Kong were reviewed. Treatment response was assessed by clinical history, physical examination, and imaging. Progression-free survival (PFS) and overall survival (OS) were estimated by the Kaplan-Meier method. Clinical predictors were analyzed by log-rank test and the Cox proportional hazard model.

Results

76 eligible patients (40 male, 36 female) were included. 59 patients received first-line gemcitabine-platinum chemotherapy—21 with GP and 38 with GC; the rest received other platinum doublets (n = 9), capecitabine-based chemotherapy (n = 7), or immunotherapy (n = 1). The median age was 58.7 years old; none of the tumors harbored EGFR or ALK mutation. The median chemotherapy cycles given was 4 for both GP/GC (range 1 – 8) and non-GP/GC (range 1 – 11). With a median follow-up of 26.0 months, the median PFS and OS for patients who received GP/GC were 9.5 and 28.6 months respectively. GP/GC had a significantly higher objective response rate (ORR) (78.0% vs 41.2%, p = 0.004) than non-GP/GC. No significant differences in ORR, PFS and OS between GP and GC were observed. On multivariate analyses, use of GP/GC was a significant predictive factor for longer PFS (HR 0.45, 95% CI 0.24 – 0.85, p = 0.013); presence of liver and bone metastasis were significant negative predictors for PFS.

Conclusions

This study confirms gemcitabine-platinum’s role as first-line treatment for relapsed or metastatic pulmonary LELC. Further studies are warranted to shape the optimal treatment landscape for this rare disease.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

The authors.

Funding

Has not received any funding.

Disclosure

All authors have declared no conflicts of interest.