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Yang Y, Yu Y, Fan Y, Li H. Evolving treatment landscape in thymic epithelial tumors: From mechanism to therapy. Biochim Biophys Acta Rev Cancer 2024; 1879:189145. [PMID: 38942215 DOI: 10.1016/j.bbcan.2024.189145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 06/19/2024] [Accepted: 06/23/2024] [Indexed: 06/30/2024]
Abstract
Thymic epithelial tumors (TETs) are rare neoplasms of the anterior mediastinum that arise from thymic epithelial cells. Although surgery is the preferred treatment for resectable TETs, the options for unresectable or recurrent advanced-stage TETs are limited beyond platinum-based chemotherapy. The evolving landscape of TET treatments is marked by significant advancements in targeted therapies and immunotherapies, particularly with anti-angiogenic agents and immune checkpoint inhibitors (ICIs). While monotherapies demonstrated certain efficacy, the development of combination strategies is vital for improving patient outcomes. This review consolidates progress in anti-angiogenic therapies and ICIs, emphasizing the evolution of combination therapies of TETs. Furtherly, we particularly discuss new first-line strategies based on these advancements and emphasizes exploring novel treatments like antibody-drug conjugates, immunomodulatory drugs and cytokine-based agents for TETs. Mechanistically, the molecular features of TETs integrated with clinical diagnosis and targeted therapy, and immunophenotyping of TETs along with its impact on the efficacy and safety of immunotherapy are discussed. Thus, this review systemizes the development in the treatment landscape of TETs, integrating the corresponding molecular and immune mechanisms, aiming to provide new references for the treatment of TETs.
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Affiliation(s)
- Yehao Yang
- Department of Thoracic Medical Oncology, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, Zhejiang 310022, China
| | - Ying Yu
- Department of Thoracic Medical Oncology, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, Zhejiang 310022, China
| | - Yun Fan
- Department of Thoracic Medical Oncology, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, Zhejiang 310022, China.
| | - Hui Li
- Department of Thoracic Medical Oncology, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, Zhejiang 310022, China.
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2
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Proto C, Ganzinelli M, Manglaviti S, Imbimbo M, Galli G, Marabese M, Zollo F, Alvisi MF, Perrino M, Cordua N, Borea F, de Vincenzo F, Chella A, Cappelli S, Pardini E, Ballatore Z, Lucarelli A, Ambrosini E, Giuliano M, Pietroluongo E, Mulargiu C, Fabbri A, Prelaj A, Occhipinti M, Brambilla M, Mazzeo L, Beninato T, Vigorito R, Ruggirello M, Greco FG, Calareso G, Miliziano D, Rulli E, De Simone I, Torri V, de Braud FGM, Pasello G, De Placido P, Berardi R, Petrini I, Zucali P, Garassino MC, Lo Russo G. Efficacy and safety of ramucirumab plus carboplatin and paclitaxel in untreated metastatic thymic carcinoma: RELEVENT phase II trial (NCT03921671). Ann Oncol 2024:S0923-7534(24)00724-5. [PMID: 38857846 DOI: 10.1016/j.annonc.2024.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 05/24/2024] [Accepted: 06/03/2024] [Indexed: 06/12/2024] Open
Abstract
BACKGROUND Thymic carcinoma (TC) is a rare tumor with aggressive behavior. Chemotherapy with carboplatin plus paclitaxel represents the treatment of choice for advanced disease. Antiangiogenic drugs, including ramucirumab, have shown activity in previously treated patients. The RELEVENT trial was designed to evaluate the activity and safety of ramucirumab plus chemotherapy as first-line treatment in advanced TC. PATIENTS AND METHODS This phase II trial was conducted within the Italian TYME network. Eligible patients had treatment-naïve advanced TC. They received ramucirumab, carboplatin and paclitaxel for six cycles, followed by ramucirumab maintenance until disease progression or intolerable toxicity. Primary endpoint was objective response rate (ORR) according to RECIST v1.1 as assessed by the investigator. Secondary endpoints were progression-free survival (PFS), overall survival (OS) and safety. Centralized radiologic review was carried out. RESULTS From November 2018 to June 2023, 52 patients were screened and 35 were enrolled. Median age was 60.8 years, 71.4% of patients were male and 85.7% had Masaoka-Koga stage IVB. The Eastern Cooperative Oncology Group performance status was 0 in 68.5% and 1 in 31.4% of patients. At the present analysis carried out some months after the interim analysis (earlier than expected) on 35 patients, ORR was 80.0% [95% confidence interval (CI) 63.1% to 91.6%]. At the centralized radiological review of 33/35 assessable patients, ORR was 57.6% (95% CI 39.2% to 74.5%). After a median follow-up of 31.6 months, median PFS was 18.1 months (95% CI 10.8-52.3 months) and median OS was 43.8 months (95% CI 31.9 months-not reached). Thirty-two out of 35 patients (91.4%) experienced at least one treatment-related adverse event (AE), of which 48.6% were AE ≥ grade 3. CONCLUSIONS In previously untreated advanced TC, the addition of ramucirumab to carboplatin and paclitaxel showed the highest activity compared to historical controls, with a manageable safety profile. Despite the small number of patients, given the rarity of the disease, the trial results support the consideration of this combination as first-line treatment in TC.
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Affiliation(s)
- C Proto
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy.
| | - M Ganzinelli
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - S Manglaviti
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - M Imbimbo
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy; Oncology Institute of Southern Switzerland, EOC, Bellinzona, Switzerland
| | - G Galli
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - M Marabese
- Laboratory of Molecular Pharmacology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan
| | - F Zollo
- Methodology for Clinical Research Laboratory, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan
| | - M F Alvisi
- Methodology for Clinical Research Laboratory, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan
| | - M Perrino
- Department of Oncology, IRCCS Humanitas Research Hospital, Rozzano, Milan
| | - N Cordua
- Department of Oncology, IRCCS Humanitas Research Hospital, Rozzano, Milan
| | - F Borea
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan
| | - F de Vincenzo
- Department of Oncology, IRCCS Humanitas Research Hospital, Rozzano, Milan
| | - A Chella
- Pneumology Unit, Azienda Ospedaliero Universitaria Pisana, Pisa
| | - S Cappelli
- Pneumology Unit, Azienda Ospedaliero Universitaria Pisana, Pisa
| | - E Pardini
- Pneumology Unit, Azienda Ospedaliero Universitaria Pisana, Pisa
| | - Z Ballatore
- Department of Medical Oncology, Azienda Ospedaliera Universitaria delle Marche, Ancona
| | - A Lucarelli
- Department of Medical Oncology, Azienda Ospedaliera Universitaria delle Marche, Ancona
| | - E Ambrosini
- Department of Clinical and Molecular Sciences, Università Politecnica delle Marche, Ancona
| | - M Giuliano
- Department of Clinical Medicine and Surgery, University Federico II, Naples; Rare Tumors Coordinating Center of Campania Region (CRCTR), Naples
| | - E Pietroluongo
- Department of Clinical Medicine and Surgery, University Federico II, Naples
| | - C Mulargiu
- Medical Oncology 2, Istituto Oncologico Veneto-IRCCS, Padua
| | - A Fabbri
- Department of Pathology, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan
| | - A Prelaj
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - M Occhipinti
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - M Brambilla
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - L Mazzeo
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - T Beninato
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - R Vigorito
- Department of Interventional Radiology, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan
| | - M Ruggirello
- Department of Interventional Radiology, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan
| | - F G Greco
- Department of Interventional Radiology, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan
| | - G Calareso
- Department of Interventional Radiology, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan
| | - D Miliziano
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - E Rulli
- Methodology for Clinical Research Laboratory, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan
| | - I De Simone
- Methodology for Clinical Research Laboratory, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan
| | - V Torri
- Methodology for Clinical Research Laboratory, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan
| | - F G M de Braud
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy; Department of Oncology and Hemato-Oncology, University of Milan, Milan
| | - G Pasello
- Medical Oncology 2, Istituto Oncologico Veneto-IRCCS, Padua; Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua
| | - P De Placido
- Department of Clinical Medicine and Surgery, University Federico II, Naples
| | - R Berardi
- Department of Clinical and Molecular Sciences, Università Politecnica delle Marche, Ancona
| | - I Petrini
- Medical Oncology, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - P Zucali
- Department of Oncology, IRCCS Humanitas Research Hospital, Rozzano, Milan; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan
| | - M C Garassino
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy; Thoracic Oncology Program, Department of Medicine, Section of Hematology/Oncology, The University of Chicago, Chicago, USA
| | - G Lo Russo
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
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Sahai V, Rothe M, Mangat PK, Garrett-Mayer E, Suhag V, Dib EG, Mehmi I, Kadakia KC, Pisick E, Duvivier HL, Le P, Li R, Michelin DP, Wilcox RE, Grantham GN, Hinshaw DC, Gregory A, Halabi S, Schilsky RL. Regorafenib in Patients With Solid Tumors With BRAF Alterations: Results From the Targeted Agent and Profiling Utilization Registry (TAPUR) Study. JCO Precis Oncol 2024; 8:e2300527. [PMID: 38603652 PMCID: PMC10896467 DOI: 10.1200/po.23.00527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 10/24/2023] [Accepted: 11/22/2023] [Indexed: 04/13/2024] Open
Abstract
PURPOSE Targeted Agent and Profiling Utilization Registry is a phase II basket trial evaluating the antitumor activity of commercially available targeted agents in patients with advanced cancer with genomic alterations known to be drug targets. Results of a cohort of patients with solid tumors with BRAF alterations treated with regorafenib are reported. METHODS Eligible patients had measurable disease (RECIST v.1.1), Eastern Cooperative Oncology Group performance status 0-1, adequate organ function, and no standard treatment options. The primary end point was disease control (DC), defined as investigator assessment of patients with complete or partial response (PR) or stable disease of at least 16-weeks duration (SD16+). Low accruing histology-specific cohorts with BRAF alterations treated with regorafenib were collapsed into a single histology-pooled cohort for this analysis. The results were evaluated on the basis of a one-sided exact binomial test with a null DC rate of 15% versus 35% (power, 0.84; α, .10). Secondary end points were objective response (OR), progression-free survival, overall survival, duration of response, duration of stable disease, and safety. RESULTS Twenty-eight patients with 12 tumor types with BRAF alterations were enrolled from June 2016 to June 2021. All patients were evaluable for efficacy. Two patients with PR and four with SD16+ were observed for DC and OR rates of 21% (90% CI, 12 to 100) and 7% (95% CI, 1 to 24), respectively. The null hypothesis of 15% DC rate was not rejected (P = .24). Eight patients had at least one grade 3 adverse event or serious adverse event at least possibly related to regorafenib. CONCLUSION Regorafenib did not meet prespecified criteria to declare a signal of activity in patients with solid tumors with BRAF alterations.
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Affiliation(s)
- Vaibhav Sahai
- University of Michigan Rogel Cancer Center, Ann Arbor, MI
| | - Michael Rothe
- American Society of Clinical Oncology, Alexandria, VA
| | - Pam K. Mangat
- American Society of Clinical Oncology, Alexandria, VA
| | | | - Vijay Suhag
- Sutter Health Roseville Cancer Center, Roseville, CA
| | - Elie G. Dib
- Michigan Cancer Research Consortium, Ypsilanti, MI
| | - Inderjit Mehmi
- The Angeles Clinic and Research Institute, A Cedars-Sinai Affiliate, Los Angeles, CA
| | | | | | | | - Phat Le
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Rui Li
- Providence Cancer Institute, Providence Portland Medical Center, Portland, OR
| | - David P. Michelin
- Munson Medical Center, Cancer Research Consortium of West Michigan, Traverse City, MI
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Maniar R, Loehrer PJ. What Have We Learned from Molecularly Informed Clinical Trials on Thymomas and Thymic Carcinomas-Current Status and Future Directions? Cancers (Basel) 2024; 16:416. [PMID: 38254905 PMCID: PMC10813974 DOI: 10.3390/cancers16020416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 01/08/2024] [Accepted: 01/11/2024] [Indexed: 01/24/2024] Open
Abstract
Thymic epithelial tumors (TETs), which include thymomas and thymic carcinomas, are a rare, heterogeneous group of malignancies that originate from the thymus gland. As an important organ of immune cell development, thymic tumors, particularly thymomas, are often associated with paraneoplastic autoimmune disorders. The advances in targeted therapies for both solid and hematologic malignancies have resulted in improved patient outcomes, including better and more durable efficacy and improved toxicity. Targeted therapies have also been investigated in the treatment of TETs, though the results have largely been modest. These have included somatostatin-receptor-targeting therapies, KIT- and EGFR-directed tyrosine kinase inhibitors, epigenetic modulators, anti-angiogenesis agents, and agents targeting the cell proliferation and survival pathways and cell cycle regulators. Numerous investigated treatments have failed or underperformed due to a lack of a strong biomarker of efficacy. Ongoing trials are attempting to expand on previous experiences, including the exploration of effective drugs in early-stage disease. Novel combination therapy strategies are also undergoing evaluation, with the goal of augmenting efficacy and understanding the toxicity while expanding the biomarkers of efficacy and safety. With advances in technology to improve target identification and drug delivery, old targets may become new opportunities, and the subsequently developed drugs may find their place in the treatment of thymic tumors.
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Affiliation(s)
| | - Patrick J. Loehrer
- Division of Hematology & Oncology, Indiana University School of Medicine, Indianapolis, IN 46202, USA;
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Shen W, Jin Y, Yu Y, Chen N, Fan Y. Small molecule multitarget antiangiogenic inhibitor treatments for advanced thymic epithelial tumors: A retrospective study. Thorac Cancer 2024; 15:122-130. [PMID: 38011005 PMCID: PMC10788475 DOI: 10.1111/1759-7714.15167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 11/03/2023] [Accepted: 11/06/2023] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND Thymic epithelial tumors (TETs) are rare malignant tumors with limited treatment options. No established second-line treatment regimen is available following the preferred first-line chemotherapy, resulting in unsatisfactory efficacy and poor prognosis for patients with advanced TETs. This study aimed to evaluate the efficacy of small molecule multitarget antiangiogenic inhibitors as well as the prognostic factors for advanced TETs. METHODS A retrospective study was conducted using data from a real-world database. Clinical information and survival follow-up data were collected from 52 patients with advanced TETs who received small molecule multitarget antiangiogenic inhibitors at Zhejiang Cancer Hospital between August 10, 2016 and August 10, 2022. The short-term efficacy of the treatments, survival time of the patients, and relevant prognostic factors of advanced TETs were analyzed. RESULTS Out of the 52 patients included in this study, 16 had thymoma and 36 had thymic carcinoma. The 52 patients had an overall response rate of 21.1% and a disease control rate of 94.2%. In addition, the median progression-free survival (PFS) was 8.05 months, and the overall survival (OS) was 25.00 months. Apatinib was given to 33 patients, anlotinib to 15 patients, and sunitinib or lenvatinib to four patients. Only seven patients received antiangiogenic inhibitors as their first-line therapy, 27 patients as their second-line therapy, and 18 patients as third-line or subsequent therapy. Meanwhile, 42 patients received monotherapy with an antiangiogenesis inhibitor, while 10 patients received combination therapy. Univariate analysis indicated that the combined treatment was associated with a superior OS (p = 0.044); multivariate analysis indicated that the combined treatment was an independent prognostic factor for PFS (p = 0.014) and OS (p = 0.012). CONCLUSION The findings suggest that small molecule multitarget antiangiogenic inhibitors are efficacious as second or post-line treatments as a viable alternative treatment option for patients with advanced TETs.
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Affiliation(s)
- Wanji Shen
- Postgraduate Training Base Alliance of Wenzhou Medical UniversityWenzhouChina
- Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM)Chinese Academy of SciencesHangzhouChina
| | - Ying Jin
- Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM)Chinese Academy of SciencesHangzhouChina
| | - Ying Yu
- Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM)Chinese Academy of SciencesHangzhouChina
- Department of OncologyThe Second Clinical Medical College, Zhejiang Chinese Medical UniversityHangzhouChina
| | - Ning Chen
- Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM)Chinese Academy of SciencesHangzhouChina
- Department of OncologyThe Second Clinical Medical College, Zhejiang Chinese Medical UniversityHangzhouChina
| | - Yun Fan
- Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM)Chinese Academy of SciencesHangzhouChina
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Agrafiotis AC, Berzenji L, Koyen S, Vermeulen D, Winthagen R, Hendriks JMH, Van Schil PE. An Overview of the Use of Anti-Angiogenic Agents in the Treatment of Thymic Epithelial Tumors. Int J Mol Sci 2023; 24:17065. [PMID: 38069386 PMCID: PMC10707176 DOI: 10.3390/ijms242317065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 11/28/2023] [Accepted: 11/30/2023] [Indexed: 12/18/2023] Open
Abstract
Angiogenesis significantly influences the carcinogenesis of thymic epithelial tumors (TET). Both thymomas and thymic carcinoma (TC) overexpress VEGF-A and VEGFR-1 and -2. This review aims to provide an appraisal of the use of anti-angiogenics in the treatment of TET. The literature research identified 16 studies that were deemed eligible for further analysis. Seven studies assessed the clinical efficacy of sunitinib and five studies the use of apatinib and/or anlotinib. The multicenter Japanese phase II REMORA trial investigated the efficacy of lenvatinib, which is a multi-targeted inhibitor of VEGFR, FGFR, RET, c-Kit, and other kinases. The objective response rate was 38% (25.6-52%), which is the highest documented in TET that progressed after first-line chemotherapy. Anti-angiogenic agents may be useful in the treatment of TET, which are not amenable to curative treatment. Their toxicity profile seems to be acceptable. However, angiogenesis inhibitors do not appear to have a major influence on either thymomas or TC, although multikinase inhibitors may have some effect on TC. The current evidence suggests that the most active agent is lenvatinib, whereas sunitinib could be proposed as an acceptable second-line therapy for TC. Further research concerning the combination of immune checkpoint inhibitors with anti-angiogenic drugs is warranted.
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Affiliation(s)
- Apostolos C. Agrafiotis
- Department of Thoracic and Vascular Surgery, Antwerp University Hospital, B-2650 Edegem, Belgium
- Department of Thoracic and Vascular Surgery, Wallonie Picarde Hospital Center (Centre Hospitalier de Wallonie Picarde—CHwapi), B-7500 Tournai, Belgium
| | - Lawek Berzenji
- Department of Thoracic and Vascular Surgery, Antwerp University Hospital, B-2650 Edegem, Belgium
| | - Stien Koyen
- Department of Thoracic and Vascular Surgery, Antwerp University Hospital, B-2650 Edegem, Belgium
| | - Dries Vermeulen
- Department of Thoracic and Vascular Surgery, Antwerp University Hospital, B-2650 Edegem, Belgium
| | - Rachel Winthagen
- Department of Thoracic and Vascular Surgery, Antwerp University Hospital, B-2650 Edegem, Belgium
| | - Jeroen M. H. Hendriks
- Department of Thoracic and Vascular Surgery, Antwerp University Hospital, B-2650 Edegem, Belgium
- ASTARC, University of Antwerp, B-2610 Wilrijk, Belgium
| | - Paul E. Van Schil
- Department of Thoracic and Vascular Surgery, Antwerp University Hospital, B-2650 Edegem, Belgium
- ASTARC, University of Antwerp, B-2610 Wilrijk, Belgium
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Agrafiotis AC, Brandão M, Berghmans T, Durieux V, Jungels C. Immunotherapy and Targeted Therapies Efficacy in Thymic Epithelial Tumors: A Systematic Review. Biomedicines 2023; 11:2722. [PMID: 37893096 PMCID: PMC10604659 DOI: 10.3390/biomedicines11102722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 09/27/2023] [Accepted: 09/28/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Thymic epithelial tumors (TET) are rare neoplasms of the anterior mediastinum. Surgery is the mainstay treatment for resectable TET, whereas systemic treatments are reserved for unresectable and metastatic tumors. The development of new treatments, such as immune checkpoint inhibitors (ICI) and targeted therapies, with promising results in other types of solid tumors, has led to the investigation of their potential efficacy in TET. The study of tumor microenvironments (TME) is another field of investigation that has gained the interest of researchers. Taking into account the complex structure of the thymus and its function in the development of immunity, researchers have focused on TME elements that could predict ICI efficacy. MATERIALS AND METHODS The primary objective of this systematic review was to investigate the efficacy of ICI in TET. Secondary objectives included the toxicity of ICI, the efficacy of targeted therapies in TET, and the evaluation of the elements of TME that may be predictive factors of ICI efficacy. A literature search was conducted in February 2023 using the Ovid Medline and SciVerse Scopus databases. RESULTS 2944 abstracts were retrieved, of which 31 were retained for the systematic review. Five phase II and one retrospective study assessed ICI efficacy. The overall response rate (ORR) varied from 0% to 34%. Median progression-free survival (PFS) ranged from 3.8 to 8.6 months, being lower in thymic carcinoma (TC) (3.8-4.2 months). Median overall survival (OS) ranged from 14.1 to 35.4 months. Treatment-related adverse events occurred in 6.6% to 27.3% of patients. Sixteen studies assessed targeted therapies. The most active molecule was lenvatinib, with 38% ORR in patients with TC while no activity was detected for imatinib, erlotinib plus bevacizumab, and saracatinib. Ten studies assessed TME elements that could predict ICI efficacy. Four studies focused on the tumor-infiltrating immune cells suggesting improved outcomes in patients with TC and high tumor-infiltrating lymphocyte densities. Another study showed that CD8+, CD20+, and CD204+ tumor-infiltrating immune cells in cancer stroma might be prognostic biomarkers in TC. Another study identified the immune-related long non-coding RNAs as a predictor of response to ICI. Tumor mutational burden was identified as a predictive factor of ICI efficacy in one study. CONCLUSIONS Despite study heterogeneity, this review shows that ICI could be a therapeutic option for selected patients with TET that are not amenable to curative radical treatment after first-line chemotherapy.
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Affiliation(s)
- Apostolos C. Agrafiotis
- Department of Thoracic and Vascular Surgery, Antwerp University Hospital, University of Antwerp, B-2650 Edegem, Belgium
- European Lung Cancer Working Party (ELCWP), 1070 Brussels, Belgium
| | - Mariana Brandão
- European Lung Cancer Working Party (ELCWP), 1070 Brussels, Belgium
- Thoracic Oncology Unit, Institut Jules Bordet, Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, 1070 Brussels, Belgium
| | - Thierry Berghmans
- European Lung Cancer Working Party (ELCWP), 1070 Brussels, Belgium
- Thoracic Oncology Unit, Institut Jules Bordet, Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, 1070 Brussels, Belgium
| | - Valérie Durieux
- European Lung Cancer Working Party (ELCWP), 1070 Brussels, Belgium
- Bibliothèque des Sciences de la Santé, Université libre de Bruxelles, 1070 Brussels, Belgium
| | - Christiane Jungels
- European Lung Cancer Working Party (ELCWP), 1070 Brussels, Belgium
- Department of Oncological Medicine, Institut Jules Bordet, Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, 1070 Brussels, Belgium
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8
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Tartarone A, Lerose R, Lettini AR, Tartarone M. Current Treatment Approaches for Thymic Epithelial Tumors. Life (Basel) 2023; 13:life13051170. [PMID: 37240815 DOI: 10.3390/life13051170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 05/07/2023] [Accepted: 05/09/2023] [Indexed: 05/28/2023] Open
Abstract
Thymic epithelial tumors (TETs), including thymoma, thymic carcinoma and neuroendocrine tumors, are uncommon tumors that originate from the epithelial cells of the thymus. Nevertheless, despite their rarity, they represent the most common tumor type located in the anterior mediastinum. Therapeutic choices based on staging and histology may include surgery with or without neoadjuvant or adjuvant therapy represented by chemotherapy, radiotherapy or chemo-radiotherapy. For patients with advanced or metastatic TETs, platinum-based chemotherapy remains the standard first-line treatment; however, some new drugs and combinations are currently under evaluation. In any case, proper management of patients with TETs requires a multidisciplinary team approach to personalize care for each patient.
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Affiliation(s)
- Alfredo Tartarone
- Department of Onco-Hematology, Division of Medical Oncology, IRCCS-CROB Referral Cancer Center of Basilicata, 85028 Rionero in Vulture, Italy
| | - Rosa Lerose
- Hospital Pharmacy, IRCCS-CROB Referral Cancer Center of Basilicata, 85028 Rionero in Vulture, Italy
| | - Alessandro Rocco Lettini
- Unit of Clinical Psychology, IRCCS-CROB Referral Cancer Center of Basilicata, 85028 Rionero in Vulture, Italy
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9
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Kuhn E, Pescia C, Mendogni P, Nosotti M, Ferrero S. Thymic Epithelial Tumors: An Evolving Field. Life (Basel) 2023; 13:life13020314. [PMID: 36836670 PMCID: PMC9964105 DOI: 10.3390/life13020314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 01/19/2023] [Accepted: 01/20/2023] [Indexed: 01/24/2023] Open
Abstract
Despite their rarity, thymic epithelial tumors (TETs) have attracted much interest over the years, leading to an impressive number of histological and staging classifications. At present, TETs are divided by the WHO classification into four main subtypes: type A, type AB, and type B thymomas (subdivided into B1, B2, and B3), and thymic carcinomas, going from the more indolent to the most aggressive ones. Among many debated staging proposals, the TNM and the Masaoka-Koga staging systems have been widely accepted and used in routine practice. The four-tiered histological classification is symmetrically mirrored by the molecular subgrouping of TETs, which identifies an A-like and an AB-like cluster, with frequent GTF2I and HRAS mutations; an intermediate B-like cluster, with a T-cell signaling profile; and a carcinoma-like cluster comprising thymic carcinomas with frequent CDKN2A and TP53 alterations and a high tumor molecular burden. Molecular investigations have opened the way to tailored therapies, such as tyrosine kinase inhibitors targeting KIT, mTOR, and VEGFR, and immune-checkpoints that have been adopted as second-line systemic treatments. In this review, we discuss the crucial events that led to the current understanding of TETs, while disclosing the next steps in this intriguing field.
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Affiliation(s)
- Elisabetta Kuhn
- S.C. Anatomia Patologica, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milano, Italy
- Dipartimento di Scienze Biomediche, Chirurgiche ed Odontoiatriche, Università degli Studi di Milano, 20122 Milano, Italy
- Correspondence: ; Tel.: +39-025-032-0564
| | - Carlo Pescia
- S.C. Anatomia Patologica, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milano, Italy
- Dipartimento di Scienze Biomediche, Chirurgiche ed Odontoiatriche, Università degli Studi di Milano, 20122 Milano, Italy
| | - Paolo Mendogni
- S.C. Chirurgia Toracica e Trapianti di Polmone, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milano, Italy
| | - Mario Nosotti
- S.C. Chirurgia Toracica e Trapianti di Polmone, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milano, Italy
- Dipartimento di Patofisiologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, 20122 Milano, Italy
| | - Stefano Ferrero
- S.C. Anatomia Patologica, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milano, Italy
- Dipartimento di Scienze Biomediche, Chirurgiche ed Odontoiatriche, Università degli Studi di Milano, 20122 Milano, Italy
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Dapergola A, Gomatou G, Trontzas I, Panagiotou E, Dimakakos E, Syrigos N, Kotteas E. Emerging therapies in thymic epithelial tumors (Review). Oncol Lett 2023; 25:84. [PMID: 36760515 PMCID: PMC9877504 DOI: 10.3892/ol.2023.13670] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Accepted: 12/13/2022] [Indexed: 01/18/2023] Open
Abstract
Thymic epithelial tumors (TETs), including thymomas and thymic carcinomas, are rare malignancies arising from the thymus gland. The optimal management requires a multidisciplinary approach. Standard first-line systemic treatment involves cytotoxic chemotherapeutic regimens; however, alternative options for systemic treatment are required. Current research focuses on the unique profile of immune-related pathogenic mechanisms of TETs, involving an overlap with certain autoimmune phenotypes, as well as on determining the landscape of oncogenic molecular alterations and the role of tumor angiogenesis. The aim of the present review is to summarize the current clinical investigation on immunotherapy and targeted agents in the management of TETs. Regarding immune checkpoint inhibitors, efficacy results are promising in certain subsets of patients; however, caution is required concerning their toxicity. Anti-angiogenic agents, mainly potent small-molecule inhibitors, have demonstrated antitumor activity in TETs, whereas other targeted agents, including KIT inhibitors and epigenetic agents, are associated with encouraging, yet still modest results for unselected populations, in the absence of predictive biomarkers. Future research should focus on identifying predictive biomarkers for patients with TETs, and should implement multicenter collaborations and appropriate clinical trials tailored for rare tumor types.
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Affiliation(s)
- Athina Dapergola
- Oncology Unit, Third Department of Medicine, ‘Sotiria’ General Hospital for Diseases of The Chest, National and Kapodistrian University of Athens, Athens 11527, Greece
| | - Georgia Gomatou
- Oncology Unit, Third Department of Medicine, ‘Sotiria’ General Hospital for Diseases of The Chest, National and Kapodistrian University of Athens, Athens 11527, Greece,Correspondence to: Dr Georgia Gomatou, Oncology Unit, Third Department of Medicine, ‘Sotiria’ General Hospital for Diseases of The Chest, National and Kapodistrian University of Athens, 152 Messogion Avenue, Athens 11527, Greece, E-mail:
| | - Ioannis Trontzas
- Oncology Unit, Third Department of Medicine, ‘Sotiria’ General Hospital for Diseases of The Chest, National and Kapodistrian University of Athens, Athens 11527, Greece
| | - Emmanouil Panagiotou
- Oncology Unit, Third Department of Medicine, ‘Sotiria’ General Hospital for Diseases of The Chest, National and Kapodistrian University of Athens, Athens 11527, Greece
| | - Evangelos Dimakakos
- Oncology Unit, Third Department of Medicine, ‘Sotiria’ General Hospital for Diseases of The Chest, National and Kapodistrian University of Athens, Athens 11527, Greece
| | - Nikolaos Syrigos
- Oncology Unit, Third Department of Medicine, ‘Sotiria’ General Hospital for Diseases of The Chest, National and Kapodistrian University of Athens, Athens 11527, Greece
| | - Elias Kotteas
- Oncology Unit, Third Department of Medicine, ‘Sotiria’ General Hospital for Diseases of The Chest, National and Kapodistrian University of Athens, Athens 11527, Greece
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Guan Y, Gu X, Si J, Xiang J, Wei J, Hao Y, Wang W, Sun Y. The efficacy of small molecule anti-angiogenic drugs in previously treated Thymic carcinoma. BMC Cancer 2023; 23:16. [PMID: 36604688 PMCID: PMC9817249 DOI: 10.1186/s12885-022-10448-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Accepted: 12/14/2022] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Antiangiogenic drugs have shown initial efficacy in the treatment of advanced thymic carcinomas (TCs); however, data are limited. In this study, we provide real-world data relating to the efficacy of antiangiogenic drugs for the treatment of patients with TCs. METHODS We retrospectively collected data on clinical progress after first-line chemotherapy in TCs patients who were treated with small molecule antiangiogenic drugs at our institution between January 2010 and December 2021. Tumor response was evaluated according to version 1.1 of the Response Evaluation Criteria in Solid Tumors. Progression free survival and overall survival were calculated using the Kaplan-Meier method. RESULTS Of the 17 patients enrolled, 13 (76.5%) received apatinib and four (23.5%) anlotinib monotherapy with an objective response rate of 23.5%. Eleven (64.7%) patients had stable disease. The median follow-up period was 46.0 months (95% confidence interval [CI], 33.0-59.0 months). The median progression survival and overall survival were 7.9 months (95% CI, 6.5-9.3) and 47.0 months (95% CI, 35.4-58.6), respectively. In the 13 patients receiving apatinib, the median PFS was 7.0 months (95% CI, 5.0-9.0), compared with 8.0 months (95% CI, 2.7-13.3 months) for patients in the anlotinib group (P = 0.945). The most common grade 3 adverse events (AEs) were hypertension (n = 3, 23.1%), followed by proteinuria and hand-foot syndrome (HFS, n = 2, 15.4%). There were no grade 4 AEs although eight patients (47.1%) required mid-course discontinuation. CONCLUSION For refractory TCs, small molecule antiangiogenic drugs are efficacious as second- or post-line treatments. The toxicity of antiangiogenic therapy is manageable.
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Affiliation(s)
- Yelan Guan
- grid.268099.c0000 0001 0348 3990Wenzhou Medical University, Wenzhou, 325035 Zhejiang China ,grid.417397.f0000 0004 1808 0985Department of Medical Oncology, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer hospital), Hangzhou, 310022 Zhejiang China ,grid.9227.e0000000119573309Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Hangzhou, 310022 Zhejiang China
| | - Xiaodong Gu
- grid.417397.f0000 0004 1808 0985Department of Medical Oncology, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer hospital), Hangzhou, 310022 Zhejiang China ,grid.9227.e0000000119573309Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Hangzhou, 310022 Zhejiang China ,grid.268505.c0000 0000 8744 8924The Second Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, 310053 Zhejiang China
| | - Jinfei Si
- grid.417397.f0000 0004 1808 0985Department of Medical Oncology, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer hospital), Hangzhou, 310022 Zhejiang China ,grid.9227.e0000000119573309Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Hangzhou, 310022 Zhejiang China ,grid.268505.c0000 0000 8744 8924The Second Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, 310053 Zhejiang China
| | - Jing Xiang
- grid.417397.f0000 0004 1808 0985Department of Medical Oncology, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer hospital), Hangzhou, 310022 Zhejiang China ,grid.9227.e0000000119573309Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Hangzhou, 310022 Zhejiang China ,grid.268505.c0000 0000 8744 8924The Second Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, 310053 Zhejiang China
| | - Jingwen Wei
- grid.268099.c0000 0001 0348 3990Wenzhou Medical University, Wenzhou, 325035 Zhejiang China ,grid.417397.f0000 0004 1808 0985Department of Medical Oncology, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer hospital), Hangzhou, 310022 Zhejiang China ,grid.9227.e0000000119573309Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Hangzhou, 310022 Zhejiang China
| | - Yue Hao
- grid.417397.f0000 0004 1808 0985Department of Medical Oncology, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer hospital), Hangzhou, 310022 Zhejiang China ,grid.9227.e0000000119573309Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Hangzhou, 310022 Zhejiang China ,grid.268505.c0000 0000 8744 8924The Second Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, 310053 Zhejiang China
| | - Wenxian Wang
- grid.417397.f0000 0004 1808 0985Department of Medical Oncology, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer hospital), Hangzhou, 310022 Zhejiang China ,grid.9227.e0000000119573309Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Hangzhou, 310022 Zhejiang China
| | - Yan Sun
- grid.268099.c0000 0001 0348 3990Wenzhou Medical University, Wenzhou, 325035 Zhejiang China ,grid.417397.f0000 0004 1808 0985Department of Medical Oncology, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer hospital), Hangzhou, 310022 Zhejiang China ,grid.9227.e0000000119573309Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Hangzhou, 310022 Zhejiang China
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Agrafiotis AC, Siozopoulou V, Hendriks JMH, Pauwels P, Koljenovic S, Van Schil PE. Prognostic factors and genetic markers in thymic epithelial tumors: A narrative review. Thorac Cancer 2022; 13:3242-3249. [PMID: 36349433 PMCID: PMC9715802 DOI: 10.1111/1759-7714.14725] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Revised: 10/25/2022] [Accepted: 10/27/2022] [Indexed: 11/11/2022] Open
Abstract
Thymic epithelial tumors (TET) are a group of rare neoplasms of the anterior mediastinum comprising thymomas and thymic carcinomas. The carcinogenesis of TET is mostly unknown. Many studies, mostly retrospective case series, have tried to establish prognostic factors in TET. TET is a very heterogeneous group of tumors with many subtypes for which diagnosis and treatment remains a very challenging task. Despite the disparities among retrospective studies, there are some prognostic factors that are more pertinent such as the completeness of resection, TNM stage and the Masaoka-Koga classification. On the other hand, the identification of different genetic pathways that result in the pathogenesis of TET represents a fascinating field of study that could possibly lead to the development of new targeted therapies. The aim of this review is to discuss the different prognostic factors and genetic markers of TET. The meticulous use of national and international databases could provide sufficient number of patients in order to draw more valid conclusions.
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Affiliation(s)
- Apostolos C. Agrafiotis
- Department of Thoracic and Vascular SurgeryAntwerp University Hospital, University of AntwerpAntwerpBelgium
| | - Vasiliki Siozopoulou
- Laboratory of PathologyAntwerp University Hospital, University of AntwerpAntwerpBelgium
| | - Jeroen M. H. Hendriks
- Department of Thoracic and Vascular SurgeryAntwerp University Hospital, University of AntwerpAntwerpBelgium
| | - Patrick Pauwels
- Laboratory of PathologyAntwerp University Hospital, University of AntwerpAntwerpBelgium
| | - Senada Koljenovic
- Laboratory of PathologyAntwerp University Hospital, University of AntwerpAntwerpBelgium
| | - Paul E. Van Schil
- Department of Thoracic and Vascular SurgeryAntwerp University Hospital, University of AntwerpAntwerpBelgium
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Conforti F, Pala L, De Pas T, He Y, Giaccone G. Investigational drugs for the treatment of thymic cancer: a focus on phase 1 and 2 clinical trials. Expert Opin Investig Drugs 2022; 31:895-904. [PMID: 35961945 DOI: 10.1080/13543784.2022.2113373] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Thymic epithelial tumors (TETs) are rare tumors of thymic epithelial cells. Treatment options for advanced disease patients who failed standard platinum-based chemotherapy are limited. AREAS COVERED Phase I and II trials published in the last five years testing new systemic treatments for advanced TET patients are discussed, as well as ongoing trials. A PubMed database literature review was conducted for articles published between January 2016 and December 2021, and ongoing clinical trials were retrieved from ClinicalTrials.gov database. EXPERT OPINION The most promising classes of new drugs in TET patients are angiogenesis inhibitors and immune checkpoint antibodies (ICIs). Sunitinib and Lenvatinib showed response rates of 26% and 38%, respectively, and ICIs showed durable responses in 20-25% in thymic carcinoma patients (TCs). Both approaches are mainly active in TCs, therefore new treatment options for thymomas is an unmet medical need.Two major new therapeutic strategies are ICIs combinations with other drugs and drugs that target pathways that are dysregulated in TETs.Future challenges include the development of preclinical models to help identify novel targets and test new treatment strategies, and randomized clinical trials to provide reliable evidence based on survival endpoints.
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Affiliation(s)
- Fabio Conforti
- Division of Medical Oncology for Melanoma, Sarcoma, and Rare Tumors, European Institute of Oncology, Milan, Italy
| | - Laura Pala
- Division of Medical Oncology for Melanoma, Sarcoma, and Rare Tumors, European Institute of Oncology, Milan, Italy
| | - Tommaso De Pas
- Division of Medical Oncology for Melanoma, Sarcoma, and Rare Tumors, European Institute of Oncology, Milan, Italy
| | - Yongfeng He
- Meyer Cancer Center, Weill Cornell Medicine, New York, USA
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