Immunotherapy-combined chemotherapy as first-line treatment for stage IIIB/IV large cell neuroendocrine lung carcinoma.

OBJECTIVES: The optimal first-line treatment for advanced large cell neuroendocrine carcinoma of the lung (LCNEC) remains unclear. This study aimed to comprehensively evaluate and compare the efficacy of different first-line treatment regimens in patients with stage IIIB/IV LCNEC. METHODS: A retrospective analysis was performed on 93 patients diagnosed with stage IIIB/IV LCNEC at The First Affiliated Hospital of Henan Medical University from March 2017 to December 2022. Based on the initial therapeutic regimen, patients were divided into three groups: chemotherapy alone (Chemotherapy group, n=55), chemotherapy combined with immunotherapy (Immunotherapy+chemotherapy group, n=23), and epidermal growth factor receptor (EGFR)-targeted therapy (Targeted therapy group, n=15; for EGFR-mutant patients). Efficacy was evaluated using objective response rate (ORR), disease control rate (DCR), progression-free survival (PFS), and overall survival (OS). RESULTS: The Chemotherapy group had a median PFS of 4.3 months and a median OS of 12.3 months. The Immunotherapy+chemotherapy group achieved an ORR of 56.5% and a DCR of 91.3%, with a significantly longer median PFS of 10.6 months compared to the Chemotherapy group (P<0.0001). The Targeted therapy group showed a median PFS of 6.9 months and a median OS of 18.8 months. Notably, the median PFS of the Immunotherapy+chemotherapy group was markedly prolonged relative to the Chemotherapy group (P<0.0001). CONCLUSIONS: Chemotherapy combined with immunotherapy may be a promising first-line treatment strategy for patients with stage IIIB/IV LCNEC, as it significantly improves PFS compared to chemotherapy alone. Additionally, targeted therapy yields encouraging outcomes in EGFR-mutant patients.