Pembrolizumab Plus Chemotherapy in Metastatic Thymic Carcinoma: A Case Report

Abstract

Metastatic thymic carcinomas have a poor prognosis. Pembrolizumab, an anti-PD-1 antibody, has recently been evaluated for patients with metastatic thymic carcinomas progressing after at least one line of platinum-based chemotherapy. The antitumor activity of immunotherapy appears to be promising for these patients and pembrolizumab in monotherapy is actually a treatment option in second metastatic line. To the best of our knowledge, we report the first case of a patient treated for metastatic thymic adenocarcinoma with a combination of chemotherapy–immunotherapy. The patient is a 46-year-old man with metastatic thymic adenocarcinoma treated in third metastatic line with a combination of pembrolizumab plus platinum-based chemotherapy with a very good metabolic tumor response. He had a progression-free survival of 7.9 months and did not experience any severe side effects related to pembrolizumab. The association of immunotherapy and chemotherapy, as in non-small cell and small cell lung cancers, could be of interest for future therapeutic trials evaluating the survival of patients with metastatic thymic carcinoma.

Brief Report on Teleconsultation in Lung Cancer: Toward a Semiotic Paradigm Shift?

“…Other studies could look more broadly at the contribution of telemedicine for thoracic oncology pathologies, such as mesothelioma or thymic tumors, for which therapeutic progress is constant. 7 , 8 …”

Good Response of Advanced Thymic Carcinoma with Low PD-L1 Expression to Chemotherapy plus Pembrolizumab as First-Line Therapy and to Pembrolizumab as Maintenance Therapy: A Case Report

“…Thomas et al reported a progression-free survival of 7.9 months in patients with thymic carcinoma with a low PD-L1 expression treated with a combination of platinum-based chemotherapy (carboplatin plus pemetrexed) and pembrolizumab as a third-line therapy followed by maintenance therapy with pembrolizumab plus pemetrexed [ 18 ]. Thomas et al believe that a chemoimmunotherapy combination is an effective therapeutic approach for thymic carcinoma with low PD-L1 expression [ 18 ].…”

“…Thomas et al reported a progression-free survival of 7.9 months in patients with thymic carcinoma with a low PD-L1 expression treated with a combination of platinumbased chemotherapy (carboplatin plus pemetrexed) and pembrolizumab as a third-line therapy followed by maintenance therapy with pembrolizumab plus pemetrexed [18]. Thomas et al believe that a chemoimmunotherapy combination is an effective therapeutic approach for thymic carcinoma with low PD-L1 expression [18]. In the current case, whether the tumor was thymic carcinoma or lung cancer was difficult to distinguish because the histological type of the tumor was squamous cell carcinoma, and the tumor was CT-guided biopsy of a pleural region showing high accumulation by PET-CT scan was performed.…”

“…The differential diagnosis between thymic carcinoma and primary lung cancer was difficult based on imaging and histopathological findings. A PET/CT scan showed a primary tumor with high 18 F-fluorodeoxyglucose accumulation, a maximum standardized uptake value of 10.95, and multiple nodules with a maximum standardized uptake value of 7.08 in the right lung interlobar region and pleura. The diagnosis was cancerous pleural dissemination (Figure 4A-F).…”

“…Figure 4.Positron emission tomography-computed tomography. Before therapy, the primary tumor's positron emission tomography-computed tomography showed high18 F-fluorodeoxyglucose accumulation and a maximum standardized uptake value of 10.95 (A-C). After therapy, the primary tumor's positron emission tomography-computed tomography showed a maximum standardized uptake value of 4.5 (D-F).…”