Challenges in Managing Metastatic EBV-Related Pulmonary Lymphoepithelioma-Like Carcinoma

Background

Pulmonary lymphoepithelioma-like carcinoma (LELC) is a rare variant of non-small cell lung cancer associated with Epstein–Barr virus (EBV) infection. Its clinical behavior can be aggressive, particularly in advanced stages, and it often presents challenges in management due to its unique pathology and treatment responses. Understanding the complexities of LELC is crucial for optimizing patient outcomes.

Data Highlights

No numerical data available in the article.

Key Findings

• The patient progressed from stage IIIB to IV with cervical lymph node and liver metastases.
• Initial treatment with pembrolizumab and chemotherapy led to a partial response.
• Persistent high-grade fever hindered the continuity of therapy and was likely tumor-associated.
• Serial plasma EBV-DNA concentrations correlated with disease activity.
• Immunotherapy was paused during the febrile phase due to concerns about treatment-related risks.

Clinical Implications

The case highlights the management of complications such as fever that can disrupt treatment. Clinicians should be aware of the aggressive nature of advanced pulmonary LELC and the potential for rapid disease progression.

Conclusion

Advanced pulmonary LELC presents significant management challenges due to its aggressive behavior and complications. Ongoing research and clinical vigilance are essential for improving treatment strategies.

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4. Long-term survival with PD-1/PD-L1 inhibitors plus platinum-based chemotherapy versus chemotherapy alone in locally advanced or metastatic pulmonary lymphoepithelioma-like carcinoma: updated follow-up analysis - ScienceDirect
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6. Frontiers in Medicine — Epstein–Barr virus-associated smooth muscle tumor of the lung in a child: a case report and literature review
7. Long-term survival with PD-1/PD-L1 inhibitors plus platinum-based chemotherapy versus chemotherapy alone in locally advanced or metastatic pulmonary lymphoepithelioma-like carcinoma: updated follow-up analysis - ScienceDirect
8. Therapy for Stage IV Non–Small Cell Lung Cancer Without Driver Alterations: ASCO Living Guideline, 2026.3.1 | Journal of Clinical Oncology