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Lymphoepithelial carcinoma of the lung is a rare lung cancer, seen mostly in East Asian non-smokers, in which cancer cells sit in a dense crowd of immune cells and usually carry the Epstein-Barr virus, like nasopharyngeal cancer. It is treated as a squamous lung cancer, and its high PD-L1 levels have made immunotherapy a natural choice.
The 2021 WHO classification moved lymphoepithelial carcinoma from the large cell group into squamous cell carcinoma, on the strength of its squamous immunophenotype (Nicholson 2022). Histologically it is a poorly differentiated carcinoma with a heavy lymphocytic infiltrate, and in East Asian patients it is nearly always associated with Epstein-Barr virus. In 66 patients from Taiwan, PD-L1 was overexpressed in 75.8 percent of tumours and EGFR mutation found in 12.1 percent, with no KRAS, BRAF, ALK or ROS1 alterations (Chang 2015). Targeted sequencing of 27 Chinese cases found no classic lung driver apart from one ERBB2 amplification and one KRAS mutation, but mutations in epigenetic regulators in 78 percent (Modern Pathology 2020).
How it differs from its parent: it lacks the smoking-related mutational burden of ordinary squamous cell carcinoma, is virus-associated, and has a better reported prognosis in the series above; its biology is closer to nasopharyngeal carcinoma, which the corpus covers.
How common: no incidence figure is published.
Treatment: as squamous cell carcinoma of the lung by stage, with platinum chemotherapy and, given the PD-L1 findings, checkpoint inhibitors in advanced disease; the sources read are pathology series, not treatment trials, and none exists for the entity.
Rare and concentrated in East Asia: the largest series in the sources read hold 66 patients (Chang 2015) and 29 patients (Modern Pathology 2020), both from China or Taiwan. No registry share exists.
Central tumours arise in the large airways, peripheral ones in the alveoli; both drain to hilar then mediastinal nodes, and the pleural lining is a separate cancer site.
Same organ: Mediastinal germ cell tumour, Pleuropulmonary blastoma (types I, Ir, II and III), Type A and type AB thymoma, Type B1 and type B2 thymoma, Type B3 thymoma, Micronodular thymoma with lymphoid stroma, Adenocarcinoma of the lung, Squamous cell carcinoma of the lung, Large cell carcinoma of the lung, Sarcomatoid carcinoma of the lung, Adenosquamous carcinoma of the lung, Invasive mucinous adenocarcinoma of the lung, Adenocarcinoma in situ and minimally invasive adenocarcinoma of the lung, Basaloid squamous cell carcinoma of the lung, Pulmonary blastoma (adult), Non-small-cell lung cancer, Lung cancer (all types), Small-cell lung cancer, Mesothelioma, Pleural mesothelioma, Thymoma and thymic carcinoma, Childhood lung and airway tumours (pleuropulmonary blastoma, tracheobronchial tumours), Inflammatory myofibroblastic tumour (IMT), EGFR-mutated non-small-cell lung cancer, ALK-positive non-small-cell lung cancer, KRAS G12C-mutant non-small-cell lung cancer, ROS1-positive non-small-cell lung cancer, MET exon 14 and MET-amplified non-small-cell lung cancer, RET fusion-positive non-small-cell lung cancer, BRAF V600E-mutant non-small-cell lung cancer, HER2-mutant non-small-cell lung cancer, NTRK fusion-positive non-small-cell lung cancer, PD-L1-high non-small-cell lung cancer without a driver mutation, Resectable stage I to III non-small-cell lung cancer, Unresectable stage III non-small-cell lung cancer, Limited-stage small-cell lung cancer, Extensive-stage small-cell lung cancer, Lung neuroendocrine tumours (typical and atypical carcinoid), Thymoma (WHO types A, AB, B1, B2 and B3), Thymic carcinoma
Treated as squamous cell carcinoma of the lung; checkpoint inhibitors in advanced disease on the PD-L1 findings, without a dedicated trial.
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Query for this cancer: (TITLE:"Lymphoepithelial carcinoma of the lung" OR ABSTRACT:"Lymphoepithelial carcinoma of the lung" OR TITLE:"Lymphoepithelioma-like carcinoma of the lung" OR ABSTRACT:"Lymphoepithelioma-like carcinoma of the lung" OR TITLE:"Pulmonary lymphoepithelioma-like carcinoma" OR ABSTRACT:"Pulmonary lymphoepithelioma-like carcinoma" OR TITLE:"LELC of the lung" OR ABSTRACT:"LELC of the lung" OR TITLE:"EBV-associated lung carcinoma" OR ABSTRACT:"EBV-associated lung carcinoma") AND (treatment OR therapy OR trial OR survival OR diagnosis). Results are unfiltered search hits about Lymphoepithelial carcinoma of the lung, not a curated reading list.
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Persistent headache with extreme tiredness, nausea, dizziness on standing or low blood pressure. Vomiting, severe weakness or collapse is adrenal crisis.
No pharmacokinetic interactions expected (antibody). See the irAE guide for toxicity management.
Immunotherapy can attack hormone-producing glands: most often the thyroid (usually ending in an under-active thyroid needing lifelong tablets), and less often the pituitary (hypophysitis) or adrenal glands, which can be life-threatening if missed.
See all on the product pages:Pembrolizumab·Printable cards in the navigator
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