Can Pemetrexed Also Have a Potential Role Preoperatively in the Management of Advanced Thymic Epithelial Tumors?

Abstract

We read with interest the article by Gbolahan et al. 1 about a phase II study testing pemetrexed in a patient with recurrences of thymoma and thymic carcinoma. In particular, they showed encouraging results in terms of response rate with use of this antifolate agent after different lines of previous chemotherapy, with a response rate of about 25%.In their conclusion, Gbolahan et al. 1 underline the fact that the potential role of this agent as first-line therapy or in association with other agents may be tested, as is indicated also for other malignancies such as lung cancer or mesothelioma. 2 With regard to this consideration, we would ask Gbolahan et al. 1 whether they intend to utilize the possibility of maintenance therapy after complete or partial response after first-line chemotherapy or as an independent initial treatment.Moreover, with regard to thymomas, we would ask Gbolahan et al. 1 whether they think that pemetrexed may also have a role in induction protocols. Indeed, different single-agent or multiagent protocols have been validated for induction treatment in advanced-stage thymomas, 3,4 but this agent is not usually used. Maybe there is a possibility of adding pemetrexed to a validated chemotherapy regimen and evaluating its efficacy in terms of response and complete resection rate in this class of patients also.