LELC, an Epstein-Barr virus (EBV)-driven cancer, is more prevalent in the nasopharynx, but can originate from other organs such as the lung and gastrointestinal ...Home/Vol5,No6(December2016)/Metastaticlymphoepithelioma-likecarcinomaofthelungtreatedwithnivolumab:acasereportandfocusedreviewof...Metastaticlymphoepithelioma-likecarcinomaofthelungtreatedwithnivolumab:acasereportandfocusedreviewofliteratureCasepresentationMs.Yisa37-year-oldChinesefemalewithahistoryoflymphoepithelioma-likecarcinoma(LELC)ofthelungandhepatitisBvirusinfectionwhohasneversmoked.Shewasinitiallydiagnosedin2012withan8.6cmmassintheleftupperlobeandunderwenttwocyclesofneoadjuvantchemotherapywithcisplatinanddocetaxelfollowedbyleftupperlobectomyandmediastinallymphnodedissection.ThepathologicstageofdiseasewasstageIIIA(T3N2M0).Afterbeinglosttofollow-upfor2years,shepresentedtotheGeorgetownLombardiComprehensiveCancerCenterin2014withathree-monthhistoryofcough,shortnessofbreath,andupperbackpain.Apositronemissiontomography-computedtomography(PET-CT)scanshowedmultiple,bilateral[18F]-fluoro-2-deoxy-D-glucose(FDG)-avidpulmonarynodules,extensivehilarandmediastinallymphadenopathy,andmultipleskeletalmetastases.Amagneticresonanceimaging(MRI)ofthespineconfirmedthepresenceofosseousmetastaticdiseasethroughoutthevertebralcolumn.AbrainMRIshowednoevidenceofintra-cranialmetastasis.PathologicevaluationoftheresectedtumorconfirmedthediagnosisofLELCofthelung(Figure1).MolecularanalysesoftheoriginaltumorshowednoEGFR,ALKorKRASgeneticalterations.Initialtreatmentconsistedofdecompressionspinalcorpectomy(C7–T3)andpalliativeradiationtherapy(10fractions)toL2–L5metastaticlesionsfollowedbysystemicchemotherapywith6cyclesofcarboplatinandpemetrexed.Thetumorwasrefractorytochemotherapywithdiseaseprogressioninthebonesandlungsanddevelopmentofhepaticmetastases(Figure2A).Thenextlineoftreatmentconsistedofnivolumab3mg/kgadministeredintravenouslyevery2weeks.Tendaysafterthefirstdoseofnivolumab,thepatientdevelopedtachypneaandcoughthatwereconcerningfo