Neoadjuvant PD-1/VEGF bispecific antibody combined with chemotherapy for locally advanced pulmonary lymphoepithelioma-like carcinoma achieving pathological complete response: a case report and literature review.

Primary pulmonary lymphoepithelioma-like carcinoma (PPLELC) is a rare Epstein-Barr virus (EBV)-associated subtype of non-small cell lung cancer (NSCLC), accounting for less than 1% of all NSCLC cases. Because prospective data are scarce, no standardized perioperative strategy has been established. We report the case of a 68-year-old female never-smoker diagnosed with stage IIIC PPLELC (cT3N3M0). The patient received four cycles of neoadjuvant therapy consisting of gemcitabine plus cisplatin in combination with ivonescimab, a novel PD-1/VEGF bispecific antibody, followed by radical surgical resection. Postoperative pathological examination revealed no residual viable tumor cells, indicating a pathological complete response (pCR). At the latest follow-up (March 2026, approximately eight months after diagnosis), no radiological evidence of recurrence or distant metastasis was observed. To our knowledge, this is the first reported case of neoadjuvant PD-1/VEGF bispecific antibody combined with chemotherapy in locally advanced PPLELC, that achieved both pCR and R0 resection. This case suggests the potential feasibility and antitumor activity of neoadjuvant ivonescimab combined with chemotherapy in locally advanced PPLELC.