Successful Treatment of a Patient with a Thymoma and Pure Red-Cell Aplasia with Octreotide and Prednisone

BACKGROUND: Although protein expressions of glucocorticoid receptor (GR), estrogen receptors (ERa and ERb), progesterone receptor A (PgR-A), and androgen receptor (AR) were shown to play roles in the growth and differentiation of normal thymus and thymic tumors, to the authors' knowledge their association with patient characteristics and prognosis has yet to be determined. METHODS: A series of 140 thymic epithelial tumors (57 type A þ AB thymomas, 40 type B1 þ B2 thymomas, 6 type B3 thymomas, and 37 thymic carcinomas) were examined for GR, ERa, ERb, PgR-A, and AR expression using immunohistochemistry. In addition, the correlation between expression of these hormone receptors and clinicopathologic factors and overall survival (OS) was assessed. RESULTS: GR and ERb demonstrated a high rate of expression in thymomas and thymic carcinomas (82.9% and 76.4%, respectively), whereas rates of ERa, PgR-A, and AR expression were low (13.6%, 0.71%, and 23.6%, respectively). A significant correlation (P < .05) was found between ERa expression and tumor size and between ERb expression and tumor stage. Multivariate analyses revealed that histologic subtype (P ¼ .0039), tumor stage (P ¼ .0012), and GR expression (P ¼ .0025) were significantly correlated with the 10-year OS rate. CONCLUSIONS: GR and ERb demonstrated high rates of expression in thymomas and thymic carcinomas. Furthermore, multivariate analysis revealed that GR expression was associated with better prognosis in patients with surgically resected thymomas and thymic carcinomas. Cancer 2011;117:4396-

Section: Discussionmentioning

confidence: 99%

Steroid receptor expression in thymomas and thymic carcinomas

Mimae

Tsuta

Takahashi

et al. 2011

“…However, the concepts that it outlines suggest hypotheses on which prospective trials can be based in the future. Such trials may improve the still dismal prognosis of high-risk thymoma patients by intensified 30 or conceptually novel 32,33 adjuvant therapeutic strategies and may prevent overtreatment of patients with lowrisk thymomas.…”

Section: Discussionmentioning

confidence: 99%

New WHO histologic classification predicts prognosis of thymic epithelial tumors

Chen

Marx

Chen

et al. 2002

355

276

BACKGROUNDIn 1999, a World Health Organization (WHO) committee published histologic criteria for distinct thymoma entities (labeled as Type A, AB, B1, B2, B3 thymomas) and for the heterogeneous group of thymic carcinomas, collectively called Type C thymomas. Whether WHO‐defined histologic thymoma subtypes are of independent prognostic relevance has yet to be proved.METHODSTwo hundred thymomas from the Shanghai Chest Hospital with a mean follow‐up time of 15 years (range, 1–246 months) were studied for the relevance of WHO histologic subtype and other factors (stage, therapy, and myasthenia gravis [MG]) for survival.RESULTSIn order of frequency, 68 patients (34.0%) had Type AB, 39 (19.5%) had Type B2, 36 (18.0%) had Type C, 27 (13.5%) had Type B3, 17 (8.5%) had Type B1, and 8 (4.0%) had Type A thymoma. Five cases (2.5%) were rare thymomas not mentioned in the WHO classification. Survival data showed significant differences among the histologic subtypes (log rank test: P < 0.001). Among patients with Type A and AB thymomas, none died of tumor; of the Type B1 thymoma patients, only one (5.9%) died at 22 months. Type B2, B3, and C thymomas had a significantly worse prognosis with 5‐year survival rates of 75.0%, 70.0%, and 48.0%, respectively. Ninety‐six patients (48.0%) were in Masaoka Stage I, 26 (13.0%) were in Stage II, 65 (32.5%) were in Stage III, and 13 (6.5%) were in Stage IV. Stage was highly significant in predicting survival (log rank, test P < 0.001). The association between histologic subtype and invasive behavior (stage) was statistically significant (P < 0.001). However, histology was an independent predictive factor of survival in Stage I and II thymomas: Type B2, B3, and C thymomas had a worse prognosis than Type A, AB, and B1 thymomas (log rank test: P < 0.003). Thirty patients (15.0%) presented with MG. MG was significantly more frequent in Type B2 and B3 than in Type A, AB, and B1 thymomas (P < 0.01). On multivariate analysis, MG had no adverse effect on survival (P = 0.17). Radiation or chemotherapy improved patients' survival at 5 and 10 years in Type B2, B3, and C thymomas (log rank test: P < 0.003).CONCLUSIONSTumor stage is the most important determinant of survival in thymoma patients, but the WHO histologic subtype is an independent prognostic factor in Stage I and II thymomas, among which WHO Type A, AB, and B1 thymomas form a low‐risk group. Patients with high‐risk thymomas might profit from novel adjuvant radiochemotherapy regimens. Cancer 2002;95:420–9. © 2002 American Cancer Society.DOI 10.1002/cncr.10665

“…14 This prompted us to administer octreotide associated with prednisone in a patient affected by malignant thymoma and pure red cell anemia; the treatment resulted in significant tumor shrinkage and resolution of the anemia, whereas the single drugs used alone were ineffective. 15 This suggested that the two compounds exerted a synergistic effect on the thymoma and on the immune mechanisms underlying pure red cell anemia. Of note, normal human thymus expresses somatostatin mRNA and somatostatin receptor subtypes (ssts) sst 1 , sst 2A and sst 3 , and cultured thymic epithelial cells expressing sst 1 and sst 2A mRNA do not proliferate under somatostatin treatment.…”

mentioning

confidence: 99%

Somatostatin analogs and prednisone in advanced refractory thymic tumors

Palmieri

Montella

Martignetti

et al. 2002

Self Cite

BACKGROUND Therapeutic options to cure advanced, recurrent, and metastatic thymic tumors are limited. Evidence of a high uptake of indium‐labeled octreotide (111In‐DTPA‐D‐Phe1‐octreotide) in thymic tumors and the curative application of somatostatin analogs and prednisone in one patient with thymoma and pure red cell aplasia led the authors to start a Phase II study. METHODS Sixteen patients with advanced thymic tumors, unresponsive to conventional chemotherapeutic regimens, were enrolled in the study. The schedule includes administration of somatostatin analog octreotide (1.5 mg/day subcutaneously) associated with prednisone (0.6 mg/kg/day orally for 3 months, 0.2 mg/kg/day orally during follow‐up). In 8 cases, octreotide was replaced by the long‐acting analog lanreotide (30 mg/every 14 days intramuscolarly). Treatment was prolonged until progression of disease was documented. Overall response rate, survival, progression free survival, and toxicity were evaluated. RESULTS The overall response rate among 16 evaluable patients was 37%. One patient (6%) had a complete response, 5 (31%) had a partial response, 6 obtained a stabilization of disease, and 4 progressed during the treatment. After a median follow‐up of 43 months, the median survival was 15 months, and median time to progression was 14 months. Treatment was generally well tolerated with acceptable toxicity: cholelithiasis (1 patient), Grade 2 cushingoid appearance (3 patients), Grade 1 diarrhea (5 patients), Grade 2 hyperglycemia (3 patients). CONCLUSIONS Treatment with somatostatin analogs and prednisone has shown efficacy in patients with recurrent and metastatic malignant thymic tumors refractory to standard therapeutic options. The results obtained are very satisfactory given the lack of effective alternative treatments. Such therapy is not burdened by the same toxicity of chemotherapy; thus, it can be administered to heavily pretreated patients. Somatostatin analogs and prednisone are well tolerated, and the long‐acting analog lanreotide, which requires fewer injections, improves patients' compliance. Cancer 2002;94:1414–20. © 2002 American Cancer Society. DOI 10.1002/cncr.10374