The Role of Chemotherapy in Advanced Thymoma

Abstract

Thymic malignancies are sensitive to a broad spectrum of systemic agents. Thymic carcinoma has a distinct clinical presentation and worse therapeutic outcomes than thymoma. Despite reproducible high response rates in thymoma, durable complete remissions are rare. Thus, novel new therapeutic targets need to be identified and appropriate agents developed to have further impact on this disease.

Thymomas and Thymic Carcinomas

“…46,83,92,93 Second-line systemic therapy includes etoposide, ifosfamide, pemetrexed, octreotide (long-acting release [LAR]; with or without prednisone), 5-FU, gemcitabine, and paclitaxel. 75,76,89,[94][95][96][97] However, none of these agents have been assessed in randomized trials. Octreotide may be useful in patients with thymoma who have a positive octreotide scan or symptoms of carcinoid syndrome.…”

“…56,[75][76][77][78][79][80][81][82][83][84][85][86][87] Although 6 different combination regimens are provided in the NCCN algorithm, cisplatin/ doxorubicin-based regimens seem to yield the best outcomes; the panel feels that cisplatin/doxorubicin/ cyclophosphamide is the preferred regimen for thymoma. 20,88,89 However, nonanthracycline regimens (eg, cisplatin/etoposide [with or without ifosfamide], carboplatin/paclitaxel) may be useful for patients who cannot tolerate the more aggressive regimens. 89,90 For thymic carcinoma, the panel recommends carboplatin/paclitaxel.…”

“…20,88,89 However, nonanthracycline regimens (eg, cisplatin/etoposide [with or without ifosfamide], carboplatin/paclitaxel) may be useful for patients who cannot tolerate the more aggressive regimens. 89,90 For thymic carcinoma, the panel recommends carboplatin/paclitaxel. 90,91 Induction therapy followed by surgery may be useful for thymic malignancies initially considered unresectable.…”

Prognostic Value of Programmed Death Ligand 1 and Programmed Death 1 Expression in Thymic Carcinoma

“…The most effective therapeutic modality for treating thymic carcinoma is surgical complete resection (1,2), which increases the 5-year overall survival (OS) from 33.3%-65.0% to 53.0%-65.7% (3)(4)(5)(6)(7)(8). Moreover, thymic carcinoma is widely recognized to respond poorly to many chemotherapeutic agents, with an objective response rate of 20%-36%, although concomitant administration of carboplatin and paclitaxel yields longer survival (9,10). Second-line treatments have also met with varying degrees of success, whereas therapeutic efficacy of sunitinib, an oral tyrosine kinase inhibitor, was recently reported in refractory patients previously treated with platinum-based chemotherapy (11).…”

Concomitant Thymic Carcinoma With Cervical and Supraclavicular Node Metastases and Thyroid Carcinoma: Report of a Case and Literature Review

“…The remainder present clinically with symptoms due to invasion or compression of intrathoracic structures, distant metastases, or paraneoplastic syndromes [3]. One third of thymoma patients will present with an invasive or advanced unresectable disease [7].…”