Efficacy and safety of immunotherapy plus chemotherapy in patients with pulmonary large cell neuroendocrine carcinoma

Abstract Purpose This study aimed to assess the efficacy and safety of immunotherapy plus chemotherapy for pulmonary large cell neuroendocrine carcinoma (LCNEC). Methods We retrospectively analyzed the data of 124 patients with LCNEC hospitalized at Shandong Cancer Hospital between January 2018 and December 2022. Among these, 45 and 79 individuals were in the immunotherapy plus chemotherapy and chemotherapy groups, respectively. Baseline data of the two groups were balanced using propensity score matching (PSM), and the Kaplan–Meier survival curve was used to evaluate the clinical efficacy of the treatment regimen. Results The median follow-up period was 33.05 months. Compared with that in the chemotherapy group, the median overall survival (OS) in patients in the immunotherapy plus chemotherapy group showed a trend of clinical benefit (26.31 vs. 16.95 months, hazard ratio HR = 0.907, P = 0.675). After the PSM, the median OS (26.31 vs. 13.56 months, HR = 0.605, P = 0.041) showed statistically significant differences between the two groups. Univariate and multivariate analyses found that patient age (P < 0.001) may be related to prognosis. In the immunotherapy plus chemotherapy group, the overall response rate was 46.7%, the disease control rate was 84.4%, and the median progression-free survival was 7.95 months (95% CI: 5.5–14.8). Simultaneously, Patients with early-stage LCNEC may obtain longer PFS by choosing immunotherapy plus chemotherapy in the first or second line. Conclusion Patients with LCNEC receiving immunotherapy plus chemotherapy may have better outcomes, with a tolerable safety profile without life-threatening adverse events.