Background and Objectives: Large cell neuroendocrine cancer is characterised by poor prognosis. The standard of treatment is still not established. The aim of this study was to assess the predictive factors of overall survival (OS) and progression-free survival (PFS) of pulmonary large cell neuroendocrine carcinoma (LCNEC) and combined LCNEC. Materials and Methods: All patients had confirmed pathology stage I-IV disease recorded between period 2002–2018. Survival curves were estimated by Kaplan–Meier method. Uni- and multivariable analysis was conducted using Cox-regression analysis. Results: A total of 132 patients with LCNEC and combined LCNEC were included. Half of them had clinical stage IIIB/C-IV. Patients were treated with radical (n = 67, including surgery alone; resection with neo-adjuvant or adjuvant chemotherapy, radiochemotherapy, or adjuvant radiotherapy; patients treated with radiochemotherapy alone), palliative (n = 41) or symptomatic (n = 24) intention. Seventeen patients were treated with resection margin R1 or R2. Non-small cell carcinoma (NSCLC) chemotherapy (platinum-vinorelbine; PN schedule) and small-cell lung carcinoma (SCLC) chemotherapy approaches (platinum/carboplatinum-etoposide; PE/KE schedule) were administered in 20 and in 55 patients, respectively. The median (95% Confidence Interval (CI)) OS and PFS were 17 months (9.0–36.2 months) and 7 months (3.0–15.0 months), respectively. Patients treated with negative resection margin, with lower clinical stage, without lymph node metastasis, and with size of primary tumour ≤4 cm showed significantly better OS and PFS. The main risk factors with an adverse effect on survival were advanced CS and positive resection margin. Conclusions: Patients with LCNEC characterized poor prognosis. Independent prognostic factors influencing PFS were initial clinical stage and resection margin R0 vs. R1-2.

Large-cell neuroendocrine carcinoma (LCNEC) is a rare malignancy with poor prognosis. The rationale of the study was to determine the survival of LCNEC patients in I–IIIA clinical stages who underwent resection. A total of 53 LCNEC (89%) and combined LCNEC (11%) patients in stages I–IIIA who underwent surgery with radical intent between 2002–2018 were included in the current study. Overall survival (OS) and time to recurrence (TTR) were estimated. Uni- and multivariable analyses were conducted using Cox-regression model. Patients were treated with surgery alone (51%), surgery with radiochemotherapy (4%), with radiotherapy (2%), with adjuvant chemotherapy (41%), or with neoadjuvant chemotherapy (2%). The median (95% Confidence Interval (CI)) OS and TTR was 52 months (20.1–102.1 months) and 20 months (7.0–75.6 months), respectively. Patients treated in clinical stage I showed better OS than patients in stages II–IIIA (p = 0.008). Patients with R0 resection margin (negative margin, no tumor at the margin) and without lymph node metastasis had significantly better TTR. In the multivariate analysis, age was an independent factor influencing OS. Recurrence within 1 year was noted in more than half cases of LCNEC. R0 resection margin and N0 status (no lymph node metastasis) were factors improving TTR. Age >64 years was observed as a main independent factor influencing OS.

Background Vibostolimab, an anti–T-cell immunoreceptor with immunoglobulin and ITIM domains (TIGIT) antibody, showed antitumor activity with pembrolizumab in non–small-cell lung cancer. Objective The KEYVIBE-008 study evaluated vibostolimab coformulated with pembrolizumab (vibostolimab/pembrolizumab) plus etoposide and platinum-based chemotherapy (EP) versus atezolizumab plus EP as first-line therapy for extensive-stage small-cell lung cancer. Methods Participants aged ≥18 years with untreated extensive-stage small-cell lung cancer were randomized 1:1 to vibostolimab/pembrolizumab (200 mg each) or atezolizumab (1200 mg) every 3 weeks, with EP and cisplatin/carboplatin for the first four cycles. The primary endpoint was overall survival. The prespecified interim analysis included a non-binding futility analysis of overall survival (futility threshold for actual number of events, P = 0.4816). Results Four hundred and sixty participants were randomized (both arms, n = 230). Median time from randomization to data cutoff (4 June, 2024) was 16.6 (range 11.3‒26.1) months. The prespecified futility criterion for overall survival was met (hazard ratio 1.26; 95% confidence interval 1.00‒1.59; P = 0.9762). There was no difference in progression-free survival (hazard ratio 1.01; 95% confidence interval 0.82‒1.23) or objective response rates (71.7% with vibostolimab/pembrolizumab vs 74.8% with atezolizumab). Grade ≥3 treatment-related adverse events occurred in 66.8% of participants treated with vibostolimab/pembrolizumab and 57.2% treated with atezolizumab. Immune-mediated adverse events and infusion reactions occurred in 39.3% and 29.7% of participants, respectively. Conclusions In this interim analysis of vibostolimab/pembrolizumab plus EP versus atezolizumab plus EP as first-line therapy for extensive-stage small-cell lung cancer, the prespecified futility criterion for overall survival was met. Grade ≥3 treatment-related adverse events and immune-mediated adverse events were more frequent with vibostolimab/pembrolizumab versus atezolizumab. Given the overall benefit/risk profile, treatment with vibostolimab/pembrolizumab was discontinued. Clinical Trial Registration Clinicaltrials.gov, NCT05224141.