Abstract
Platinum-based chemotherapy is the de facto standard treatment for metastatic or unresectable thymic carcinoma. The optimal chemotherapy regimen has not yet been determined, including whether this should be combined with a second- or third-generation anti-cancer agent. We retrospectively evaluated the data of patients with metastatic or unresectable thymic carcinoma who were treated with a combination of cisplatin and irinotecan as first-line chemotherapy between 2002 and 2021 (trial registration UMIN000012175). The primary endpoint was response rate according to the RECIST criteria version 1.1. Secondary endpoints were disease control rate, progression-free survival (PFS), overall survival (OS), and toxicity (adverse events). Some patients analyzed in this study were also included in the previous trial, which was terminated early. For this analysis, we included 18 patients with a median age of 56 years and an Eastern Cooperative Oncology Group performance status of 0 or 1. All patients had clinical stage IVa or IVb thymic carcinoma according to the Masaoka-Koga staging system. The response rate was 44% and the disease control rate was 89%. The median PFS was 8.4 months (95% confidence interval (CI): 2.7–11.6 months) and the median OS was 45.6 months (95% CI: 15.7–69.1 months). Grade 3 or worse hematological toxicity was observed in 5 patients and grade 3 or worse non-hematological toxicity was observed in 3 patients. None of the patients developed febrile neutropenia, and no treatment-related deaths occurred. Thus, the combination of cisplatin and irinotecan as first-line chemotherapy for metastatic thymic carcinoma showed efficacy and acceptable toxicity.
Highlights
Thymic carcinoma is a rare cancer arising from the mediastinum originating from thymic epithelial cells, accounting for approximately 5% of all thymic epithelial tumors [1]
Eighteen patients with previously untreated metastatic/ unresectable thymic carcinoma were treated with irinotecan and cisplatin
Our long-term experience with cisplatin and irinotecan combination chemotherapy for unresectable or metastatic thymic carcinoma demonstrated clinical effectiveness and tolerability, which is in line with previous studies (Table 5)
Summary
Thymic carcinoma is a rare cancer arising from the mediastinum originating from thymic epithelial cells, accounting for approximately 5% of all thymic epithelial tumors [1]. The standard of care for metastatic thymic carcinoma is palliative chemotherapy. The key drugs for treating thymic malignancies include platinum and doxorubicin containing chemotherapy used in the Einhorn protocol [3] including CAP (cisplatin, doxorubicin, cyclophosphamide, and prednisone) [4], CODE (cisplatin, vincristine, doxorubicin, and etoposide) [5], ADOC (cisplatin, doxorubicin, vincristine, and cyclophosphamide) [6], and VIP (etoposide, ifosfamide, and cisplatin) regimens [7, 8]. Doxorubicin does not tend to be beneficial in the treatment of thymic carcinoma; a combination of carboplatin and paclitaxel is commonly used owing to its satisfactory response rate, time-to-event data, and toxicity profile [9,10,11]. There is minimal evidence of the effectiveness of first- or later-line chemotherapy for thymic malignancies. The key drugs or optimal strategy for the treatment of thymic carcinoma are gradually being revealed, but there is still ample room for development
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