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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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Song Z, Lou G, Wang Y, Yang Z, Wang W, Ji Y, Chen S, Xu C, Hu X, Zhang Y. Apatinib in patients with recurrent or metastatic thymic epithelial tumor: a single-arm, multicenter, open-label, phase II trial. BMC Med 2022; 20:154. [PMID: 35534877 PMCID: PMC9088066 DOI: 10.1186/s12916-022-02361-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 03/29/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Thymic epithelial tumors (TETs) are rare malignancies and the treatment options are limited. We aimed to evaluate the efficacy and safety of apatinib, an angiogenesis inhibitor, in advanced TETs. METHODS This was an open-label, single-arm, phase II trial at three centers in China. Patients with TET who had progressed after failure of at least one line of platinum-based chemotherapy were enrolled. Patients received apatinib 500 mg orally per day. The primary endpoint was objective response rate (ORR). Secondary endpoints were progression-free survival (PFS), overall survival (OS), disease control rate (DCR), and safety. RESULTS From June 29, 2017, to April 18, 2019, 25 patients were enrolled. At data cut off (September 30, 2021), one patient achieved complete response, nine achieved partial response, and 11 achieved stable disease, with an ORR of 40% (95% CI 21-61%) and DCR of 84% (95% CI 64-95%). The median PFS was 9.0 (95% CI 5.4-12.6) months. The median OS was 24.0 (95% CI 8.2-39.8) months. All patients reported treatment-related adverse events (TRAEs). Grade 3 TRAEs occurred 26 times in 15 patients. No grade 4 or 5 toxicities occurred. CONCLUSIONS This is the first trial of apatinib for the treatment of TETs. Apatinib showed promising antitumor activity and the toxicities were tolerable and manageable.
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Affiliation(s)
- Zhengbo Song
- Department of Clinical Trial, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou, 310022, Zhejiang, China
| | - Guangyuan Lou
- Department of Medical Oncology, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou, 310022, Zhejiang, China
| | - Yina Wang
- Department of Medical Oncology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310000, Zhejiang, China
| | - Zhiping Yang
- Department of Medical Oncology, The First Hospital of Jiaxing, Jiaxing, 314000, Zhejiang, China
| | - Wenxian Wang
- Department of Medical Oncology, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou, 310022, Zhejiang, China
| | - Yongling Ji
- Department of Radiotherapy Oncology, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou, 310022, Zhejiang, China
| | - Shiqing Chen
- The Medical Department, 3D Medicines Inc., Shanghai, 201114, China
| | - Chunwei Xu
- Department of Respiratory Medicine, Jinling Hospital, Nanjing University School of Medicine,Nanjing, 210002,, Jiangsu, China
| | - Xiao Hu
- Department of Radiotherapy Oncology, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou, 310022, Zhejiang, China
| | - Yiping Zhang
- Department of Medical Oncology, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou, 310022, Zhejiang, China.
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3
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Zhan P, Chen X, Wu XY, Hou ZB, Qian Q, Zhang Y, Zou J, Zhang YQ, Wan MY, Wang JD, Yu LK, Xie HY. Mutation analysis of the EGFR gene and its downstream signaling pathway in thymic carcinoma patients from a Chinese Han population. CLINICAL RESPIRATORY JOURNAL 2016; 12:601-607. [PMID: 27731926 DOI: 10.1111/crj.12569] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Revised: 09/24/2016] [Accepted: 09/28/2016] [Indexed: 12/21/2022]
Abstract
INTRODUCTION For thymic carcinoma (TC), which is a rare epithelial neoplasm of the thymus gland, median survival with current treatments is only 2 years. OBJECTIVES Mutations in the epidermal growth factor receptor (EGFR) gene or its downstream effectors may cause constitutive activation that leads to cell proliferation and metastases. Thus, molecular profiling is essential for selecting TC patients who may respond to anti-EGFR therapies. METHODS Genomic DNA was extracted from 61 histological samples of TCs. Real-time polymerase chain reaction (PCR) and direct sequencing were used to assess the mutations in the EGFR downstream pathway. RESULTS Gene mutations were identified in seven patients (11.5%). In particular, the identified mutations included four mutations in the KRAS gene, one mutation in the BRAF gene, one mutation in the PIK3CA gene, and only one mutation in the EGFR gene itself. Gene mutations in the EGFR downstream pathway were associated with shorter survival time and were observed to be an independent prognostic factor for TC patients. CONCLUSION Mutations in the EGFR downstream pathway are not rare in TCs. These data offer interesting possibilities for the future management of TCs, particularly in the era of new targeted therapies.
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Affiliation(s)
- Ping Zhan
- Department of Respiratory Medicine, Nanjing Chest Hospital, School of Medicine, Southeast University, Nanjing, 210029, China.,Clinical Center of Nanjing Respiratory Diseases and Imaging, Nanjing, 210029, China
| | - Xiao Chen
- Department of Pathology, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Xiao-Yuan Wu
- Central Laboratory, Nanjing Chest Hospital, School of Medicine, Southeast University, Nanjing, 210029, China
| | - Zhi-Bo Hou
- Department of Respiratory Medicine, Nanjing Chest Hospital, School of Medicine, Southeast University, Nanjing, 210029, China.,Clinical Center of Nanjing Respiratory Diseases and Imaging, Nanjing, 210029, China
| | - Qian Qian
- Department of Respiratory Medicine, Nanjing Chest Hospital, School of Medicine, Southeast University, Nanjing, 210029, China.,Clinical Center of Nanjing Respiratory Diseases and Imaging, Nanjing, 210029, China
| | - Yu Zhang
- Department of Respiratory Medicine, Nanjing Chest Hospital, School of Medicine, Southeast University, Nanjing, 210029, China.,Clinical Center of Nanjing Respiratory Diseases and Imaging, Nanjing, 210029, China
| | - Jue Zou
- Department of Pathology, Nanjing Chest Hospital, School of Medicine, Southeast University, Nanjing, 210029, China
| | - Yuan-Qing Zhang
- Department of Pathology, Nanjing Chest Hospital, School of Medicine, Southeast University, Nanjing, 210029, China
| | - Ming-Yue Wan
- Department of Pathology, Nanjing Chest Hospital, School of Medicine, Southeast University, Nanjing, 210029, China
| | - Jian-Dong Wang
- Department of Pathology, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Li-Ke Yu
- Department of Respiratory Medicine, Nanjing Chest Hospital, School of Medicine, Southeast University, Nanjing, 210029, China.,Clinical Center of Nanjing Respiratory Diseases and Imaging, Nanjing, 210029, China
| | - Hai-Yan Xie
- Department of Respiratory Medicine, Nanjing Chest Hospital, School of Medicine, Southeast University, Nanjing, 210029, China.,Clinical Center of Nanjing Respiratory Diseases and Imaging, Nanjing, 210029, China
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Bolzacchini E, Chini C, Pinotti G. Response of Malignant Thymoma to Sorafenib. J Thorac Oncol 2016; 11:e125-6. [DOI: 10.1016/j.jtho.2016.07.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Accepted: 07/13/2016] [Indexed: 10/21/2022]
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Okuma Y, Hosomi Y, Miyamoto S, Shibuya M, Okamura T, Hishima T. Correlation between S-1 treatment outcome and expression of biomarkers for refractory thymic carcinoma. BMC Cancer 2016; 16:156. [PMID: 26915359 PMCID: PMC4766615 DOI: 10.1186/s12885-016-2159-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Accepted: 02/10/2016] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Thymic carcinoma is a rare cancer with minimal evidence of a survival benefit following chemotherapy. An oral fluoropyrimidine of S-1, however, is the recommended active cytotoxic chemotherapy agent for refractory thymic carcinoma based on a case series, whereas sunitinib or everolimus are recommended as molecular-targeted agents based on Phase II trials. We retrospectively investigated the efficacy of S-1 for refractory thymic carcinoma and performed a biomarker analysis. METHODS We assessed the clinicopathological variables of 14 consecutive patients who underwent S-1 for refractory thymic carcinoma and correlated the clinical outcomes with potential biomarkers using paraffin-embedded cancer tissues of eight patients in the cohort. RESULTS A total of 178 thymic malignancies were identified, of whom 14 patients included 12 cases of squamous cell carcinoma, one lymphoepithelioma-like carcinoma, and one undifferentiated carcinoma. Six patients exhibited a partial response (42.9 %: 95 % confidence interval [CI], 21.4-67.4) and the disease control rate was 85.7 % (60.0-96.0 %). After a median follow-up of 24.2 months, the median progression-free survival was 8.1 months (range, 2.6-12.2 months), and median overall survival was 30.0 months (range, 6.2-41.9 months). No significant correlation between biomarker expression and response was noted. However, thymidine synthase (TS)/dihydropyrimidine dehydrogenase and TS/orotate phosphoribosyltransferase were observed. CONCLUSIONS S-1 for refractory thymic carcinoma offered clinical activity and achieved an 85 % disease control rate. Although the biomarkers did not correlate with clinical outcome, the study results showed efficacy of S-1 as a cytotoxic chemotherapy for refractory thymic carcinoma, which warrants future investigation.
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Affiliation(s)
- Yusuke Okuma
- Department of Thoracic Oncology and Respiratory Medicine, Tokyo Metropolitan Cancer and Infectious diseases Center Komagome Hospital, 3-18-22 Honkomagome, Bunkyo, Tokyo, 113-8677, Japan.
- Division of Oncology, Research Center for Medical Sciences, The Jikei University School of Medicine, Minato, Tokyo, Japan.
| | - Yukio Hosomi
- Department of Thoracic Oncology and Respiratory Medicine, Tokyo Metropolitan Cancer and Infectious diseases Center Komagome Hospital, 3-18-22 Honkomagome, Bunkyo, Tokyo, 113-8677, Japan.
| | - Shingo Miyamoto
- Department of Clinical Oncology, Japan Red Cross Medical Center, Shibuya, Tokyo, Japan.
| | - Masahiko Shibuya
- Department of Thoracic Oncology and Respiratory Medicine, Tokyo Metropolitan Cancer and Infectious diseases Center Komagome Hospital, 3-18-22 Honkomagome, Bunkyo, Tokyo, 113-8677, Japan.
| | - Tatsuru Okamura
- Department of Thoracic Oncology and Respiratory Medicine, Tokyo Metropolitan Cancer and Infectious diseases Center Komagome Hospital, 3-18-22 Honkomagome, Bunkyo, Tokyo, 113-8677, Japan.
| | - Tsunekazu Hishima
- Department of Pathology, Tokyo Metropolitan Cancer and Infectious diseases Center Komagome Hospital, Bunkyo, Tokyo, Japan.
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Simonelli M, Zucali PA, Suter MB, Lorenzi E, Rubino L, Fatuzzo G, Alloisio M, Santoro A. Targeted therapy for thymic epithelial tumors: a new horizon? Review of the literature and two cases reports. Future Oncol 2016; 11:1223-32. [PMID: 25832879 DOI: 10.2217/fon.14.318] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Surgical resection remains the cornerstone of therapy for early-stage thymic epithelial tumors (TETs), while in advanced or recurrent forms, a multimodality approach incorporating radiation and chemotherapy is required. Given the absence of effective treatment options for metastatic/refractory TETs and the poor related prognosis, there is a compelling need to identify promising 'drugable' molecular targets. Initial reports of activity from targeted agents in TETs derived from anecdotal cases have been often associated with specific activating mutations. Only in recent years, several agents have been formally investigated into prospective clinical trials, with varying success rates. We reviewed the literature on targeted therapy in TETs along with two cases of thymoma achieving striking responses to sorafenib in combination with lapatinib.
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Affiliation(s)
- Matteo Simonelli
- Humanitas Cancer Center, Oncology & Hematology Unit, Istituto Clinico Humanitas IRCCS, 20089 Rozzano MI, Italy
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7
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Hirai F, Edagawa M, Shimamatsu S, Toyozawa R, Toyokawa G, Nosaki K, Yamaguchi M, Seto T, Twakenoyama M, Ichinose Y. c-kit mutation-positive advanced thymic carcinoma successfully treated as a mediastinal gastrointestinal stromal tumor: A case report. Mol Clin Oncol 2016; 4:527-529. [PMID: 27073655 DOI: 10.3892/mco.2016.752] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Accepted: 01/20/2016] [Indexed: 01/09/2023] Open
Abstract
Thymic carcinoma is an exceptionally rare tumor, which has a very poor prognosis, differing from thymoma. Although cytotoxic chemotherapy is commonly used to treat advanced thymic carcinoma, its effectiveness has not been found to be sufficient. There are several reports that thymic carcinoma also harbors an oncogenic driver mutation, similar to lung cancer. A patient with a c-kit mutation-positive thymic carcinoma received imatinib followed by sunitinib consecutively, which are both c-Kit inhibitors. Although the patient had achieved long-term disease control for 21 months, the primary lesion and pulmonary metastases had increased in size by November, 2014. Following failure of imatinib treatment, the patient received sunitinib, a multiple kinase inhibitor, initiated in December, 2014. Following administration of sunitinib, a computed tomography scan revealed a partial response and the disease was effectively controlled with continued sunitinib treatment for 6 months, up to June, 2015. The patient achieved long-term disease control (~27 months) with imatinib followed by sunitinib. The efficacy of consecutive molecular-targeted therapy for thymic carcinoma was demonstrated in this case. Therefore, thymic carcinoma with oncogenic driver mutations should be treated with molecular-targeted agents rather than with cytotoxic drugs, and it may be suitable to treat c-kit mutation-positive thymic carcinoma as a mediastinal gastrointestinal stromal tumor.
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Affiliation(s)
- Fumihiko Hirai
- Department of Thoracic Oncology, National Kyushu Cancer Center, Fukuoka, Fukuoka 811-1395, Japan
| | - Makoto Edagawa
- Department of Thoracic Oncology, National Kyushu Cancer Center, Fukuoka, Fukuoka 811-1395, Japan
| | - Shinichiro Shimamatsu
- Department of Thoracic Oncology, National Kyushu Cancer Center, Fukuoka, Fukuoka 811-1395, Japan
| | - Ryo Toyozawa
- Department of Thoracic Oncology, National Kyushu Cancer Center, Fukuoka, Fukuoka 811-1395, Japan
| | - Gouji Toyokawa
- Department of Thoracic Oncology, National Kyushu Cancer Center, Fukuoka, Fukuoka 811-1395, Japan
| | - Kaname Nosaki
- Department of Thoracic Oncology, National Kyushu Cancer Center, Fukuoka, Fukuoka 811-1395, Japan
| | - Masafumi Yamaguchi
- Department of Thoracic Oncology, National Kyushu Cancer Center, Fukuoka, Fukuoka 811-1395, Japan
| | - Takashi Seto
- Department of Thoracic Oncology, National Kyushu Cancer Center, Fukuoka, Fukuoka 811-1395, Japan
| | - Mitsuhiro Twakenoyama
- Department of Thoracic Oncology, National Kyushu Cancer Center, Fukuoka, Fukuoka 811-1395, Japan
| | - Yukito Ichinose
- Department of Thoracic Oncology, National Kyushu Cancer Center, Fukuoka, Fukuoka 811-1395, Japan
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Scorsetti M, Leo F, Trama A, D'Angelillo R, Serpico D, Macerelli M, Zucali P, Gatta G, Garassino MC. Thymoma and thymic carcinomas. Crit Rev Oncol Hematol 2016; 99:332-50. [PMID: 26818050 DOI: 10.1016/j.critrevonc.2016.01.012] [Citation(s) in RCA: 185] [Impact Index Per Article: 23.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Revised: 12/09/2015] [Accepted: 01/14/2016] [Indexed: 12/15/2022] Open
Abstract
Thymomas (Ts) and thymic carcinomas (TCs) are rare tumours of the mediastinum with an incidence rate of 1.7/million per year in Europe. Histological classification is based on rate of non-malignant-appearing thymic epithelial cells and proportions of lymphocytes (A, AB, B1, B2, B3, and C), while staging system concerns localisation of the involved areas. Surgery is the mainstay of treatment with a 10-year survival of 80%, 78%, 75%, and 42% for stages I, II, III and IV, respectively, with an R0 resection. Radiotherapy has a role in selected cases (stage III patients or R1-2 residual) and platinum-based chemotherapy remains the standard of care for patients with advanced disease. A multimodality approach would be advisable when surgery is not recommended. Since molecular aberrations are poorly understood and few responses are reported, targeted therapies are yet being studied. In this review, we describe key aspects of clinical management for Ts and TCs.
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Affiliation(s)
- Marta Scorsetti
- Radiotherapy and Radiosurgery Department, Humanitas Clinical and Research Centre, Rozzano, Milan, Italy
| | - Francesco Leo
- Thoracic Surgery Service, Périgueux Hospital, Périgueux, France
| | - Annalisa Trama
- Evaluative Epidemiology, Fondazione IRCCS-Italian National Cancer Institute, Milan, Italy
| | | | - Danila Serpico
- Evaluative Epidemiology, Fondazione IRCCS-Italian National Cancer Institute, Milan, Italy
| | - Marianna Macerelli
- Thoracic Oncology Unit, Division of Medical Oncology, Foundation IRCCS-Italian National Cancer Institute, Milan, Italy.
| | - Paolo Zucali
- Medical Oncology and Haematology Unit, Humanitas Clinical and Research Centre, Rozzano, Milan, Italy
| | - Gemma Gatta
- Evaluative Epidemiology, Fondazione IRCCS-Italian National Cancer Institute, Milan, Italy
| | - Marina Chiara Garassino
- Thoracic Oncology Unit, Division of Medical Oncology, Foundation IRCCS-Italian National Cancer Institute, Milan, Italy
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9
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Song Z, Yu X, Zhang Y. Chemotherapy and prognosis in advanced thymic carcinoma patients. Clinics (Sao Paulo) 2015; 70:775-80. [PMID: 26735216 PMCID: PMC4676312 DOI: 10.6061/clinics/2015(12)03] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Accepted: 08/26/2015] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE The role of chemotherapy in treating advanced thymic carcinoma is unclear. The purpose of the current study was to investigate the efficacy of chemotherapy and the prognostic factors for patients with advanced thymic carcinoma. METHODS A retrospective review of the medical records of 86 patients treated with chemotherapy for advanced thymic carcinoma was conducted between 2000 and 2012 at our institution. The clinical characteristics, chemotherapy regimens and prognostic factors were analyzed. Survival curves were plotted using the Kaplan-Meier method and the Cox proportional hazard model was used for multivariate analysis. RESULTS Of the 86 patients, 56 were male and 30 were female. The median survival time was 24.5 months. For the first-line chemotherapy treatment, the objective response rate was 47.7% and the disease control rate was 80.2%. The median progression-free survival for all patients was 6.5 months for first-line chemotherapy. No significant differences in progression-free survival were observed among the different chemotherapy regimens. Multivariate analyses revealed that the prognostic factors for overall survival included performance status (p=0.043), histology grade (p=0.048), and liver metastasis (p=0.047). CONCLUSION Our results suggest that there is no difference in efficacy between multiagent and doublet regimens. The prognosis of patients with advanced thymic carcinoma can be predicted based on histological grade, liver metastasis and performance status.
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Affiliation(s)
- Zhengbo Song
- Zhejiang Cancer Hospital, Department of Medical Oncology, Hangzhou, China
| | - Xinmin Yu
- Zhejiang Cancer Hospital, Department of Medical Oncology, Hangzhou, China
| | - Yiping Zhang
- Zhejiang Cancer Hospital, Department of Medical Oncology, Hangzhou, China
- Corresponding author: E-mail:
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10
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Kossai M, Duchemann B, Boutros C, Caramella C, Hollebecque A, Angevin E, Gazzah A, Bahleda R, Ileana E, Massard C, Vielh P, Soria J, Besse B. Antitumor activity in advanced cancer patients with thymic malignancies enrolled in early clinical drug development programs (Phase I trials) at Gustave Roussy. Lung Cancer 2015; 89:306-10. [DOI: 10.1016/j.lungcan.2015.06.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2015] [Revised: 06/08/2015] [Accepted: 06/14/2015] [Indexed: 12/12/2022]
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11
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Zhan P, Xie H, Yu LK. Response to nab-paclitaxel and nedaplatin in a heavily-metastatic thymic carcinoma: A case report. Oncol Lett 2015; 9:1715-1718. [PMID: 25789028 PMCID: PMC4356389 DOI: 10.3892/ol.2015.2953] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Accepted: 01/13/2015] [Indexed: 11/06/2022] Open
Abstract
Metastatic thymic carcinoma is an aggressive cancer that usually responds poorly to multimodal therapies. Although surgical resection is the preferred treatment for patients with advanced or metastatic disease, the clinical prognosis is typically poor. The present study describes a 63-year-old patient with thymic carcinoma who underwent a range of antitumor treatments, including surgical resection, post-operative radiotherapy and post-operative chemotherapy with several drugs, but ultimately responded to treatment with nab-paclitaxel (nab-P) and nedaplatin. Subsequent to six cycles of nab-P and nedaplatin, the lung and peritoneal metastases decreased in size and the pleural effusion was reduced. To the best of our knowledge, this is the first study to describe the response of an advanced thymic carcinoma to nab-P chemotherapy.
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Affiliation(s)
- Ping Zhan
- Department of Respiratory Medicine, Nanjing Chest Hospital, Nanjing, Jiangsu, P.R. China ; Nanjing Clinical Center of Respiratory Diseases, Nanjing, Jiangsu, P.R. China
| | - Haiyan Xie
- Department of Respiratory Medicine, Nanjing Chest Hospital, Nanjing, Jiangsu, P.R. China ; Nanjing Clinical Center of Respiratory Diseases, Nanjing, Jiangsu, P.R. China
| | - Li-Ke Yu
- Department of Respiratory Medicine, Nanjing Chest Hospital, Nanjing, Jiangsu, P.R. China ; Nanjing Clinical Center of Respiratory Diseases, Nanjing, Jiangsu, P.R. China
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12
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Serpico D, Trama A, Haspinger ER, Agustoni F, Botta L, Berardi R, Palmieri G, Zucali P, Gallucci R, Broggini M, Gatta G, Pastorino U, Pelosi G, de Braud F, Garassino MC. Available evidence and new biological perspectives on medical treatment of advanced thymic epithelial tumors. Ann Oncol 2014; 26:838-847. [PMID: 25411417 DOI: 10.1093/annonc/mdu527] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Accepted: 10/27/2014] [Indexed: 12/14/2022] Open
Abstract
Thymic epithelial tumors (TETs) are rare primary mediastinal tumors arising from thymic epithelium. Their rarity and complexity hinder investigations of their causes and therapy development. Here, we summarize the existing knowledge regarding medical treatment of these tumors, and thoroughly review the known genetic aberrations associated with TETs and the present status of potential biological treatments. Epidermal growth factor receptor (EGFR), stem-cell factor receptor, insulin-like growth factor-1 receptor (IGF1R), and vascular endothelial growth factors (VEGF-A, VEGF-B, and VEGF-2) are overexpressed in TETs. EGFR overexpression in TETs is associated with higher stage, and IGF1R overexpression has poor prognostic value. Data indicate that anti-IGF1R monoclonal antibodies, and inhibitors of angiogenesis, somatostatin receptors, histone deacetylase, mammalian target of rapamycin, and cyclin-dependent kinases may be active against TETs. Continued investigations in this field could lead to advancement of targeted and biological therapies for TETs.
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Affiliation(s)
- D Serpico
- Thoracic Oncology Unit, Department of Medical Oncology
| | - A Trama
- Evaluative Epidemiology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan
| | - E R Haspinger
- Thoracic Oncology Unit, Department of Medical Oncology
| | - F Agustoni
- Thoracic Oncology Unit, Department of Medical Oncology
| | - L Botta
- Evaluative Epidemiology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan
| | - R Berardi
- Department of Medical Oncology, Universita Politecnica delle Marche, Ancona
| | - G Palmieri
- Department of Molecular and Clinical Endocrinology and Oncology, 'Federico II', University, Naples
| | - P Zucali
- Department of Oncology and Hematology, Humanitas Cancer Center, Rozzano
| | - R Gallucci
- Thoracic Oncology Unit, Department of Medical Oncology
| | - M Broggini
- Laboratory of Molecular Pharmacology, IRCCS 'Mario Negri', Milan
| | - G Gatta
- Evaluative Epidemiology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan
| | | | | | - F de Braud
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - M C Garassino
- Thoracic Oncology Unit, Department of Medical Oncology.
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13
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Response to cytotoxic chemotherapy in patients previously treated with palliative-intent chemotherapy for advanced thymic carcinoma. Clin Lung Cancer 2014; 16:221-7. [PMID: 25468802 DOI: 10.1016/j.cllc.2014.10.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Revised: 10/23/2014] [Accepted: 10/28/2014] [Indexed: 01/09/2023]
Abstract
BACKGROUND Clinical efficacy of second- and later-line chemotherapy for patients with thymic carcinoma previously treated with chemotherapy remains uncertain; limited data are available about this carcinoma because of its rarity. The aim of this study was to investigate effective chemotherapy for patients with thymic carcinoma previously treated with chemotherapy using a retrospective analysis of responses and times to event. PATIENTS AND METHODS We conducted a retrospective review of the medical records of 23 advanced thymic carcinoma patients previously treated with palliative-intent chemotherapy between 1980 and 2014 in our institution. Clinical demographic characteristics, agents, response, and time to treatment failure for each treatment line and overall survival were reviewed. Factors expected to be associated with survival rates were analyzed. Differences in survival were assessed using Kaplan-Meier analysis and univariate and multivariate Cox proportional hazards regression analyses. RESULTS The study included 13 men (56.5%) and 10 women (43.5%). The median age at diagnosis was 58.5 years. The most common histological subtypes were squamous cell carcinoma (16 patients [69.6%]), followed by neuroendocrine carcinoma (4 patients [17.4%]). The objective response rates of first-, second-, third-, and fourth-line chemotherapy were 60.9%, 39.1%, 23.1%, and 25.0%, respectively. The median survival time was 18.8 months (95% confidence interval, 7.5-40.9 months). Uni- and multivariate analyses of all assessed variables failed to identify any statistically significant indicators of overall survival. CONCLUSION Patients with thymic carcinoma previously treated with palliative-intent chemotherapy might respond to second- or later-lines of cytotoxic chemotherapy.
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14
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Lattanzio R, La Sorda R, Facciolo F, Sioletic S, Lauriola L, Martucci R, Gallo E, Palmieri G, Evoli A, Alessandrini G, Ruco L, Rendina EA, Truini M, Chiarle R, Barreca A, Pich A, Ascani S, Remotti D, Tunesi G, Granone P, Ratto GB, Puma F, Pescarmona E, Piantelli M, Marino M, Carlini S, Cerasoli V, Corzani F, Melis E, Filippetti M, Canalini P, Palestro G, Lalle M, Ruffini E, Ceribelli A, Rinaldi M. Thymic epithelial tumors express vascular endothelial growth factors and their receptors as potential targets of antiangiogenic therapy: A tissue micro array-based multicenter study. Lung Cancer 2014; 85:191-6. [DOI: 10.1016/j.lungcan.2014.05.010] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2014] [Revised: 04/12/2014] [Accepted: 05/08/2014] [Indexed: 01/11/2023]
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15
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Chen L, Wu K. [Research status of molecular targeted therapy in thymic epithelial tumors]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2014; 17:487-90. [PMID: 24949690 PMCID: PMC6000099 DOI: 10.3779/j.issn.1009-3419.2014.06.09] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
In recent years, as the study of molecular mechanism and signal transduction pathways of tumors, molecular target therapy in many solid tumors has made great progress. At present, more and more studies focus on molecular target drugs in thymic epithelial tumors and people have got some experience. Molecular target therapy may be a new therapeutic option for patients of thymic epithelial tumor.
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Affiliation(s)
- Lizhu Chen
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China; Fujian Provincial Cancer Hospital, Fuzhou 350014, China
| | - Kailiang Wu
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
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16
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Song Z, Yu X, He C, Zhang B, Zhang Y. Docetaxel-based chemotherapy as second-line regimen for advanced thymic carcinoma. Thorac Cancer 2014; 5:169-73. [PMID: 26766995 DOI: 10.1111/1759-7714.12064] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2013] [Accepted: 07/01/2013] [Indexed: 12/16/2022] Open
Abstract
Thymic carcinoma is an uncommon neoplasm. The efficacy of second-line treatment with docetaxel in advanced thymic carcinoma has not been well studied. Therefore, we conducted a review of the efficacy of docetaxel-based chemotherapy as a second-line regimen for advanced thymic carcinoma. Fifteen patients with advanced thymic carcinoma who received second-line chemotherapy with docetaxel singlet or docetaxel/platinum combination chemotherapy regimens were retrospectively reviewed. There were 11 males and four females, with a median age of 53 years. Squamous cell carcinoma was most common (n = 10), followed by undifferentiated carcinoma (n = 4), and small cell carcinoma (n = 1). Eight patients received docetaxel/platinum combination chemotherapy and seven docetaxel mono-therapy. Four patients showed partial responses, representing a response rate of 26.7%. The median progression-free survival and overall survival in the 15 patients were 4.0 (2.8-5.2) and 22.0 (14.6-29.4) months, respectively. There was no difference in progression-free survival between the docetaxel singlet or docetaxel/platinum combination chemotherapy (3.5 months vs. 4.0 months, P = 0.889). A docetaxel-based regimen could be a potential therapeutic option as a second-line chemotherapy for advanced thymic carcinoma.
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Affiliation(s)
- Zhengbo Song
- Department of Chemotherapy, Zhejiang Cancer Hospital Hangzhou, China; Key Laboratory Diagnosis and Treatment Technology on Thoracic Oncology Hangzhou, China
| | - Xinmin Yu
- Department of Chemotherapy, Zhejiang Cancer Hospital Hangzhou, China; Key Laboratory Diagnosis and Treatment Technology on Thoracic Oncology Hangzhou, China
| | - Chunxiao He
- Department of Chemotherapy, Zhejiang Cancer Hospital Hangzhou, China; Key Laboratory Diagnosis and Treatment Technology on Thoracic Oncology Hangzhou, China
| | - Beibei Zhang
- Department of Chemotherapy, Zhejiang Cancer Hospital Hangzhou, China; Key Laboratory Diagnosis and Treatment Technology on Thoracic Oncology Hangzhou, China
| | - Yiping Zhang
- Department of Chemotherapy, Zhejiang Cancer Hospital Hangzhou, China; Key Laboratory Diagnosis and Treatment Technology on Thoracic Oncology Hangzhou, China
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17
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Girard N. Chemotherapy and targeted agents for thymic malignancies. Expert Rev Anticancer Ther 2014; 12:685-95. [DOI: 10.1586/era.12.29] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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18
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Abstract
The rarity of thymic malignancies prevents us from performing large randomized clinical trials. As a result, systemic treatment decisions are often guided by a small amount of prospective trial data, retrospective series, and individual case reports. In recent years, we have begun to unravel the molecular biology of thymic tumors. It is becoming more apparent as a result of gene expression profiling and genomic clustering studies that the subclassifications of type A, AB, B1, B2, B3, and thymic carcinoma have different molecular features that may be clinically relevant. Genomic profiling distinguishes type B3 thymoma and thymic carcinoma as distinct entities from type A and type B2 thymoma. Furthermore, type B2 thymomas can be separated from other subgroups in that it has a more distinct lymphocytic component than the other groups where epithelial cells predominate. Next generation RNA sequencing has recently identified a large microRNA cluster on chromosome 19q13.42 in types A and AB thymomas, which is absent in type B thymomas and thymic carcinomas. This cluster has been shown to result in activation of the phosphoinositide 3-kinase (PI3K)/AKT pathway, which suggests a possible role for PI3K inhibitors in these subtypes. The presence of KIT mutations in thymic carcinomas is also well described. Herein we discuss the chemotherapeutic and targeted treatment options for advanced thymic malignancies and highlight important advances in our understanding of the molecular biology of these rare tumors.
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Affiliation(s)
- Ronan J Kelly
- From the Bunting Blaustein Cancer Research Building, the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore, MD
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19
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Berardi R, De Lisa M, Pagliaretta S, Onofri A, Morgese F, Savini A, Ballatore Z, Caramanti M, Santoni M, Mazzanti P, Cascinu S. Thymic neoplasms: an update on the use of chemotherapy and new targeted therapies. A literature review. Cancer Treat Rev 2013; 40:495-506. [PMID: 24355362 DOI: 10.1016/j.ctrv.2013.11.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2013] [Revised: 11/10/2013] [Accepted: 11/12/2013] [Indexed: 12/14/2022]
Abstract
Thymic malignancies represent a wide range of clinical, histological and molecular entities, with probably considerable heterogeneity even among tumors of the same histotype. Systemic chemotherapy with cisplatin-based regimens continues to represent the standard of care in metastatic or inoperable refractory/recurrent diseases and ADOC regimen (including cisplatin, doxorubicin, vincristine and cyclophosphamide) demonstrated the longer overall response rate and median survival in the first line setting, although no randomized trial is available; and there is still a lack of standard treatment after first-line failure. To date research efforts are focused on translational studies on molecular pathways involved in thymic tumors carcinogenesis, aimed to better understand and predict the efficacy of chemotherapy and targeted therapy. Recent molecular characterization includes identification of a number of oncogenes, tumor suppressor genes, chromosomal aberrations, angiogenic factors, and tumor invasion factors involved in cellular survival and proliferation and in tumor growth. The use of biologic drugs is currently not recommended in a routine practice because there are limited data on their therapeutic role in thymic epitelial tumors. Because of the lack of data from adequate-sized, prospective trials are required for validation and the enrolment of patients with advanced disease into available clinical trials has to be encouraged.
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Affiliation(s)
- Rossana Berardi
- Medical Oncology, Università Politecnica delle Marche, Azienda Ospedaliero-Universitaria Ospedali Riuniti Umberto I, GM Lancisi, G Salesi, Ancona, Italy.
| | - Mariagrazia De Lisa
- Medical Oncology, Università Politecnica delle Marche, Azienda Ospedaliero-Universitaria Ospedali Riuniti Umberto I, GM Lancisi, G Salesi, Ancona, Italy
| | - Silvia Pagliaretta
- Medical Oncology, Università Politecnica delle Marche, Azienda Ospedaliero-Universitaria Ospedali Riuniti Umberto I, GM Lancisi, G Salesi, Ancona, Italy
| | - Azzurra Onofri
- Medical Oncology, Università Politecnica delle Marche, Azienda Ospedaliero-Universitaria Ospedali Riuniti Umberto I, GM Lancisi, G Salesi, Ancona, Italy
| | - Francesca Morgese
- Medical Oncology, Università Politecnica delle Marche, Azienda Ospedaliero-Universitaria Ospedali Riuniti Umberto I, GM Lancisi, G Salesi, Ancona, Italy
| | - Agnese Savini
- Medical Oncology, Università Politecnica delle Marche, Azienda Ospedaliero-Universitaria Ospedali Riuniti Umberto I, GM Lancisi, G Salesi, Ancona, Italy
| | - Zelmira Ballatore
- Medical Oncology, Università Politecnica delle Marche, Azienda Ospedaliero-Universitaria Ospedali Riuniti Umberto I, GM Lancisi, G Salesi, Ancona, Italy
| | - Miriam Caramanti
- Medical Oncology, Università Politecnica delle Marche, Azienda Ospedaliero-Universitaria Ospedali Riuniti Umberto I, GM Lancisi, G Salesi, Ancona, Italy
| | - Matteo Santoni
- Medical Oncology, Università Politecnica delle Marche, Azienda Ospedaliero-Universitaria Ospedali Riuniti Umberto I, GM Lancisi, G Salesi, Ancona, Italy
| | - Paola Mazzanti
- Medical Oncology, Università Politecnica delle Marche, Azienda Ospedaliero-Universitaria Ospedali Riuniti Umberto I, GM Lancisi, G Salesi, Ancona, Italy
| | - Stefano Cascinu
- Medical Oncology, Università Politecnica delle Marche, Azienda Ospedaliero-Universitaria Ospedali Riuniti Umberto I, GM Lancisi, G Salesi, Ancona, Italy
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20
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Lamarca A, Moreno V, Feliu J. Thymoma and thymic carcinoma in the target therapies era. Cancer Treat Rev 2013; 39:413-20. [DOI: 10.1016/j.ctrv.2012.11.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2012] [Revised: 11/14/2012] [Accepted: 11/19/2012] [Indexed: 10/27/2022]
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21
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Clinical outcomes with chemotherapy for advanced thymic carcinoma. Lung Cancer 2013; 80:75-80. [DOI: 10.1016/j.lungcan.2012.12.012] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2012] [Revised: 12/02/2012] [Accepted: 12/05/2012] [Indexed: 12/31/2022]
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22
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Rossi V, Donini M, Sergio P, Passalacqua R, Rossi G, Buti S. When a thymic carcinoma "becomes" a GIST. Lung Cancer 2013; 80:106-8. [PMID: 23375402 DOI: 10.1016/j.lungcan.2013.01.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2012] [Revised: 12/29/2012] [Accepted: 01/03/2013] [Indexed: 11/29/2022]
Abstract
Thymic carcinoma (TC) is a rare intrathoracic malignancy that it can be invasive and refractory to conventional treatment. Comprehensive genomic analysis evidenced a molecularly distinct subset of thymic carcinoma with high prevalence of c-kit mutation, which may behave as a gastrointestinal stromal tumor (GIST). Here, we present a case report of TC with c-Kit mutation, who has relapsed after exposure to multiple lines of combination chemotherapy, but he has shown an impressive and long lasting response to sunitinib after imatinib failure.
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Affiliation(s)
- Valentina Rossi
- Department of Medical Oncology, Istituti Ospitalieri of Cremona, Italy.
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23
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Weissferdt A, Wistuba II, Moran CA. Molecular aspects of thymic carcinoma. Lung Cancer 2012; 78:127-32. [PMID: 22921473 DOI: 10.1016/j.lungcan.2012.08.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2012] [Revised: 07/26/2012] [Accepted: 08/05/2012] [Indexed: 02/03/2023]
Abstract
Thymic carcinomas are tumors of the anterior mediastinum derived from the epithelial cells of the thymic gland. Due to their low incidence they are often investigated in combination with thymomas under the rubric of "thymic epithelial neoplasms" and studies exclusively addressing thymic carcinomas are sparse. Thymic carcinomas are characterized by their histologic variability, often resembling tumors seen in other organ systems. This morphologic variation coupled with their rarity has prevented large scale research of these tumors and little is known about the etiology, biologic behavior or best treatment for thymic carcinoma. In recent years, attempts have been made to investigate the molecular characteristics of these tumors in the hope that molecular profiling can be used to predict the prognosis or lead to the development of new treatment strategies. Herein we provide an overview of the recent advances of the molecular analysis of thymic carcinoma with particular emphasis on the potential use for molecularly targeted therapies.
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Affiliation(s)
- Annikka Weissferdt
- Department of Pathology, MD Anderson Cancer Center, Houston, TX 77030, USA.
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24
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Neuhaus T, Luyken J. Long lasting efficacy of sorafenib in a heavily pretreated patient with thymic carcinoma. Target Oncol 2012; 7:247-51. [PMID: 23090205 DOI: 10.1007/s11523-012-0235-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2012] [Accepted: 10/08/2012] [Indexed: 12/23/2022]
Abstract
Thymoma and thymic carcinoma are rare neoplasms of the mediastinum, arising from the epithelial cells of the thymus. While surgical resection is the treatment of choice in early stages, platin-based chemotherapy is mainly used in patients with advanced or metastatic disease; however, the prognosis is poor. Here we present the case of a 54 year old female patient suffering from a CD117-negative thymic carcinoma with widespread metastases. After several courses of different kinds of chemotherapy, finally these approaches failed to be effective. Thus we initiated a treatment with sorafenib, an inhibitor of several receptor tyrosine kinases. The treatment was tolerated very well, and within a few weeks the general condition of the patient improved significantly. A CT-scan, performed 3 months after therapy with sorafenib started, showed a 50 % reduction of tumor size, and this effect lasted for 15 months. When the carcinoma relapsed again, we administered another course of chemotherapy and, because of lacking success, we even tried to use sunitinib. However, the patient died in a septic shock, based on progressive disease. In summary, we present a patient with metastastic thymic carcinoma, in which sorafenib led to a tumor-control for 18 months.
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25
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Evans TL. Emerging treatment options for patients with recurrent advanced thymic epithelial tumors. Onco Targets Ther 2012; 5:177-84. [PMID: 22973113 PMCID: PMC3439855 DOI: 10.2147/ott.s23267] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
The purpose of this review article is to review recent advances in the treatment of advanced thymic epithelial tumors. These tumors are generally responsive to cytotoxic combination chemotherapy in the first-line setting. While newer agents have shown efficacy in the salvage setting, there is no one standard approach. A multitude of targeted agents have shown promise generally in case reports, though as of yet, nothing has shown consistent benefit. Because of the rarity of thymic epithelial tumors, clinical trial enrollment is difficult but nevertheless essential.
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Affiliation(s)
- Tracey L Evans
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
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26
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Schirosi L, Nannini N, Nicoli D, Cavazza A, Valli R, Buti S, Garagnani L, Sartori G, Calabrese F, Marchetti A, Buttitta F, Felicioni L, Migaldi M, Rea F, Di Chiara F, Mengoli MC, Rossi G. Activating c-KIT mutations in a subset of thymic carcinoma and response to different c-KIT inhibitors. Ann Oncol 2012; 23:2409-2414. [PMID: 22357254 DOI: 10.1093/annonc/mdr626] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/06/2023] Open
Abstract
BACKGROUND To analyze a multi-institutional series of type C thymic carcinomas (TCs) (including neuroendocrine tumors), focusing on the expression and mutations of c-KIT. MATERIALS AND METHODS Immunohistochemical expression of c-KIT/CD117, p63, CD5 and neuroendocrine markers, as well as mutational analysis of c-KIT exons 9, 11, 13, 14, 17 by direct sequencing of 48 cases of TCs. Immunohistochemical and molecular data were statistically crossed with clinicopathological features. RESULTS Overall, 29 tumors (60%) expressed CD117, 69% were positive for CD5 and 85% (41 cases) for p63. Neuroendocrine markers stained all six atypical carcinoids and five poorly-differentiated thymic squamous cell carcinomas. Overall, six CD117-positive cases (12.5%) showed c-KIT mutation. No mutation was detected in CD117-negative tumors and carcinoids. All the mutations were found in poorly-differentiated thymic squamous cell carcinomas expressing CD117, CD5, p63 and lacking neuroendocrine markers (6 of 12 cases with these features). Mutations involved exon 11 (four cases: V559A, L576P, Y553N, W557R), exon 9 (E490K) and exon 17 (D820E). CONCLUSIONS All TCs need an immunohistochemical screening with CD117, while c-KIT mutation analysis is mandatory only in CD117-positive cases, particularly when coexpressing CD5 and p63, lacking neuroendocrine differentiation. The finding of c-KIT mutation can predict efficacy with different c-KIT inhibitors.
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Affiliation(s)
- L Schirosi
- Section of Pathologic Anatomy, University Clinic Policlinico of Modena, Modena
| | - N Nannini
- Department of Diagnostic Medical Sciences and Special Therapies, Special Pathological Anatomy Section, University of Padua Medical School, Padova
| | - D Nicoli
- Laboratory of Molecular Biology, Hospital St. Maria Nuova, Reggio Emilia
| | - A Cavazza
- Section of Pathologic Anatomy, Hospital St. Maria Nuova, Reggio Emilia
| | - R Valli
- Section of Pathologic Anatomy, Hospital St. Maria Nuova, Reggio Emilia
| | - S Buti
- Oncology Division, Hospital of Cremona, Cremona
| | - L Garagnani
- Section of Pathologic Anatomy, University Clinic Policlinico of Modena, Modena
| | - G Sartori
- Section of Pathologic Anatomy, University Clinic Policlinico of Modena, Modena
| | - F Calabrese
- Department of Diagnostic Medical Sciences and Special Therapies, Special Pathological Anatomy Section, University of Padua Medical School, Padova
| | - A Marchetti
- Center of Predictive Molecular Medicine, Center of Excellence on Aging, University of Chieti, Chieti
| | - F Buttitta
- Center of Predictive Molecular Medicine, Center of Excellence on Aging, University of Chieti, Chieti
| | - L Felicioni
- Center of Predictive Molecular Medicine, Center of Excellence on Aging, University of Chieti, Chieti
| | - M Migaldi
- Section of Pathologic Anatomy, University Clinic Policlinico of Modena, Modena
| | - F Rea
- Division of Thoracic Surgery, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua Medical School, Padova, Italy
| | - F Di Chiara
- Division of Thoracic Surgery, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua Medical School, Padova, Italy
| | - M C Mengoli
- Section of Pathologic Anatomy, University Clinic Policlinico of Modena, Modena
| | - G Rossi
- Section of Pathologic Anatomy, University Clinic Policlinico of Modena, Modena.
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27
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Koppitz H, Rockstroh JK, Schüller H, Standop J, Skowasch D, Müller-Hermelink HK, Schmidt-Wolf IG. State-of-the-art classification and multimodality treatment of malignant thymoma. Cancer Treat Rev 2012; 38:540-8. [DOI: 10.1016/j.ctrv.2011.11.010] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2011] [Revised: 11/28/2011] [Accepted: 11/30/2011] [Indexed: 12/23/2022]
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28
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Kelly RJ, Petrini I, Rajan A, Wang Y, Giaccone G. Thymic malignancies: from clinical management to targeted therapies. J Clin Oncol 2011; 29:4820-7. [PMID: 22105817 PMCID: PMC3675690 DOI: 10.1200/jco.2011.36.0487] [Citation(s) in RCA: 105] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2011] [Accepted: 08/03/2011] [Indexed: 12/14/2022] Open
Abstract
PURPOSE A key challenge in the treatment of thymoma and thymic carcinoma (TC) is in improving our understanding of the molecular biology of these relatively rare tumors. In recent years, significant efforts have been made to dissect the molecular pathways involved in their carcinogenesis. Here we discuss the results of large-scale genomic analyses conducted to date and review the most active chemotherapies and targeted treatments. METHODS We reviewed the literature for chemotherapeutic trials in the last 20 years and trials involving targeted therapies between 1999 and 2010. The search was supplemented by a review of abstracts presented at the annual meetings of the American Society of Clinical Oncology (from 1999 to 2010), at the first International Conference on Thymic Malignancies in 2009, and at a follow-up meeting of the newly formed International Thymic Malignancies Interest Group in 2010. RESULTS Surgery remains the treatment of choice for operable tumors, whereas chemotherapy is standard in locally advanced and metastatic disease. Thus far, targeted therapies have been developed empirically. Histone deacetylase inhibitors have shown some activity in thymoma whereas sunitinib may be active in TC. There are no data to support the use of HER2- or EGFR-targeted therapies in thymic malignancies. CONCLUSION Drug development for the treatment of thymic malignancies is difficult because of the rarity of these tumors. Ethnic differences are becoming apparent, with aggressive subtypes being observed in Asians and African Americans. Incremental improvements in our understanding of tumor biology suggest that molecular profiling-directed therapies may be the preferred route of investigation in the future.
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Affiliation(s)
- Ronan J. Kelly
- All authors: National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Iacopo Petrini
- All authors: National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Arun Rajan
- All authors: National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Yisong Wang
- All authors: National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Giuseppe Giaccone
- All authors: National Cancer Institute, National Institutes of Health, Bethesda, MD
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29
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Combination Chemotherapy with Doxorubicin, Vincristine, Cyclophosphamide, and Platinum Compounds for Advanced Thymic Carcinoma. J Thorac Oncol 2011; 6:2130-4. [DOI: 10.1097/jto.0b013e31822e71c0] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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30
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Okuma Y, Hosomi Y, Takagi Y, Iguchi M, Okamura T, Shibuya M. Cisplatin and irinotecan combination chemotherapy for advanced thymic carcinoma: Evaluation of efficacy and toxicity. Lung Cancer 2011; 74:492-6. [DOI: 10.1016/j.lungcan.2011.05.013] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2010] [Revised: 05/02/2011] [Accepted: 05/16/2011] [Indexed: 10/18/2022]
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31
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Dişel U, Oztuzcu S, Beşen AA, Karadeniz C, Köse F, Sümbül AT, Sezer A, Nursal GN, Abalı H, Ozyılkan O. Promising efficacy of sorafenib in a relapsed thymic carcinoma with C-KIT exon 11 deletion mutation. Lung Cancer 2011; 71:109-12. [PMID: 20970876 DOI: 10.1016/j.lungcan.2010.09.011] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2010] [Revised: 09/12/2010] [Accepted: 09/19/2010] [Indexed: 11/18/2022]
Abstract
Advanced thymic carcinoma (TC) is a very aggressive disease. To date there are no established treatment options for the refractory and recurrent disease and only a few prospective trials have been conducted in patients with TC. Here we present a case of a relapsed TC patient, who, by using combination chemotherapy, showed a positive response to sorafenib with C-KIT exon 11 mutation.
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Affiliation(s)
- Umut Dişel
- Baskent University, School of Medicine, Dept. of Medical Oncology, Adana, Turkey.
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Abstract
INTRODUCTION Thymic malignancies are rare intrathoracic tumors that may be aggressive and difficult to treat in advanced stage. Over the past years, significant efforts have been conducted to dissect the molecular pathways involved in the carcinogenesis of these tumors. Insights have been made following anecdotal clinical responses to targeted therapies, and large-scale genomic analyses have been conducted. METHODS Review of the literature, 1990-2010. RESULTS The Epidermal Growth Factor Receptor (EGFR) is frequently overexpressed in thymomas and thymic carcinomas, but EGFR mutations are exceptional, and this does not support the use of EGFR tyrosine kinase inhibitors. On the contrary, single observations of responses create a basis for further evaluation of cetuximab in thymomas. KIT-mutant thymic carcinomas represent a small molecular subset of thymic tumors. The clinical relevance of KIT mutations is more limited in thymic carcinoma than in GIST as KIT mutations are far less frequent (7% of thymic carcinomas) and are not correlated with KIT expression; furthermore, KIT mutants are not uniformly sensitive to imatinib. Beyond EGFR and KIT signaling pathways, other molecular alterations with potential prognostic or predictive relevance are emerging in thymic malignancies. CONCLUSIONS Given the rarity of these tumors, translation of preclinical findings to the clinic may be quick and represents one of the most promising therapeutic approaches for advanced-stage thymic malignancies.
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Ströbel P, Hohenberger P, Marx A. Thymoma and thymic carcinoma: molecular pathology and targeted therapy. J Thorac Oncol 2011; 5:S286-90. [PMID: 20859121 DOI: 10.1097/jto.0b013e3181f209a8] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Thymomas and thymic carcinomas (TC) are rare epithelial tumors of the thymus. Although most thymomas have organotypic features (i.e., resemble the normal thymus), TC are morphologically undistinguishable from carcinomas in other organs. Apart from their different morphology, TC and thymomas differ also in functional terms (TC, in contrast to thymomas, have lost the capacity to promote the maturation of intratumorous lymphocytes), have different genetic features (discussed in this review), a different immunoprofile (most TC overexpress c-KIT, whereas thymomas are consistently negative), and different clinical features (TC, in contrast to thymomas, are not associated with paraneoplastic myasthenia gravis). Thus, although all the data suggest that the biology of thymomas and TC is different, in clinical practice, their therapeutic management up to now is identical. In the age of personalized medicine, the time may have come to think this over. We will briefly review the molecular genetics of malignant thymic tumors, summarize the current status of targeted therapies with an emphasis on the multitargeted kinase inhibitors sunitinib and sorafenib, and try to outline some future directions.
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Affiliation(s)
- Philipp Ströbel
- Institute of Pathology, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany.
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Abstract
BACKGROUND Overexpression of c-kit, a tyrosine kinase receptor protein encoded by the protooncogene kit, has been previously reported in thymic epithelial tumors and in other neoplasms such as gastrointestinal stromal tumors, myeloproliferative disorders, melanoma, and seminoma. Mutations in the kit gene have been related to response to imatinib in gastrointestinal stromal tumor and one case report of thymic carcinoma. We studied expression of c-kit in a large retrospective series of thymic epithelial malignancies and sequenced the whole gene in a subset of patients. METHODS Thymic epithelial tumors from 120 patients (13 thymic carcinomas and 107 thymomas) were examined. Immunohistochemical staining with an antic-kit polyclonal antibody was performed on a tissue microarray. Mutation analyses of exons 1 to 20 were conducted by direct DNA sequencing of polymerase chain reaction products in eight thymic carcinomas, five thymomas, and one thymic carcinoma cell line. RESULTS The percentage of c-kit positive cells was significantly higher in thymic carcinoma (46%) than in thymoma (4%). Decreased disease-related survival and progression-free survival were observed in c-kit positive tumors. No mutations were detected. CONCLUSION c-kit expression is strongly but not exclusively related to thymic carcinoma histotype, and it is of prognostic value. Mutations are very rare.
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Abstract
The use of targeted therapies for the treatment of thymic malignancies is documented in the literature. However, only a few drugs have undergone evaluation in phase II trials. Most of the evidence for the benefit of biologic therapies for thymic malignancies is in the form of case reports and small case series. No major activity has been observed with any agent so far, likely due to the lack of selection of patients for targeted therapies and the small numbers studied. A better understanding of the biology of these tumors will be essential in furthering the field.
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Affiliation(s)
- Arun Rajan
- Medical Oncology Branch, National Cancer Institute, Bethesda, Maryland 20892, USA
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Abstract
Thymomas are rare epithelial tumors that display significant heterogeneity. Thymomas are usually indolent; however, thymic carcinomas are typically invasive with a high risk of relapse and death. Current treatment approaches are primarily based on clinical stage. Surgery is the mainstay for treatment of early stage disease, whereas multimodality therapy is required for advanced disease. The most important prognostic factors are stage and histology; however, increasing recognition of disease heterogeneity has led to recent exploration of underlying molecular mechanisms. Molecular characterization of thymic tumors may offer strategies to improve diagnosis, therapy, and prognosis. This article describes recently identified molecular characteristics of thymoma and thymic carcinoma that may potentially impact disease classification, targeted therapeutic decision making, and design of future clinical trials.
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Weiss GJ. Thymic carcinoma: current and future therapeutic interventions. Expert Opin Investig Drugs 2010; 19:1007-16. [DOI: 10.1517/13543784.2010.504708] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Ströbel P, Bargou R, Wolff A, Spitzer D, Manegold C, Dimitrakopoulou-Strauss A, Strauss L, Sauer C, Mayer F, Hohenberger P, Marx A. Sunitinib in metastatic thymic carcinomas: laboratory findings and initial clinical experience. Br J Cancer 2010; 103:196-200. [PMID: 20571495 PMCID: PMC2906735 DOI: 10.1038/sj.bjc.6605740] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Thymic carcinoma (TC) is a rare aggressive tumour. Median survival with current treatments is only 2 years. Sunitinib is a multi-targeted tyrosine kinase inhibitor that has shown benefit in various other cancers. METHODS Laboratory analyses of snap-frozen tumour tissues were performed to detect activation and genetic mutations of receptor tyrosine kinases (RTKs) in TC samples. On the basis of molecular analyses showing activation of multiple RTKs in their tumour, four patients with metastatic TCs refractory to conventional therapies were treated with sunitinib according to standard protocols. RESULTS RTK analysis in three of the patients showed activation of multiple RTKs, including platelet-derived growth factor-beta and vascular endothelial growth factor 3. Mutations of EGFR, c-KIT, KRAS, and BRAF genes were not found. Administration of sunitinib yielded a partial remission (lasting 2 to 18+ months) according to the RECIST criteria in three patients and stable disease with excellent metabolic response in 18F-FDG-PET in another one. The overall survival with sunitinib treatment ranges from 4 to 40+ months. Withdrawal of the drug in one patient prompted rapid tumour progression that could be controlled by re-administration of sunitinib. CONCLUSIONS Sunitinib is an active treatment for metastatic TC. A panel of molecular analyses may be warranted for optimal patient selection.
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Affiliation(s)
- P Ströbel
- Institute of Pathology, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68135 Mannheim, Germany.
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Girard N, Shen R, Guo T, Zakowski MF, Heguy A, Riely GJ, Huang J, Lau C, Lash AE, Ladanyi M, Viale A, Antonescu CR, Travis WD, Rusch VW, Kris MG, Pao W. Comprehensive genomic analysis reveals clinically relevant molecular distinctions between thymic carcinomas and thymomas. Clin Cancer Res 2009; 15:6790-9. [PMID: 19861435 DOI: 10.1158/1078-0432.ccr-09-0644] [Citation(s) in RCA: 147] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
PURPOSE Thymomas and thymic carcinomas are rare intrathoracic malignancies that can be invasive and refractory to conventional treatment. Because these tumors both originate from the thymus, they are often grouped together clinically. However, whether the underlying biology of these tumors warrants such clustering is unclear, and the optimum treatment of either entity is unknown. EXPERIMENTAL DESIGN All thymic tumors were profiled for mutations in genes encoding components of the EGFR and KIT signaling pathways, assessed for EGFR and KIT expression by immunohistochemistry, and analyzed by array-based comparative genomic hybridization. Previously untreated tumors were subjected to global gene expression arrays. RESULTS We analyzed 45 thymic tumors [thymoma, n = 38 (type A, n = 8; type B2, n = 22; type B3, n = 8); thymic carcinoma, n = 7]. One thymoma and one thymic carcinoma harbored KRAS mutations (G12A and G12V, respectively), and one thymoma had a G13V HRAS mutation. Three tumors displayed strong KIT staining. Two thymic carcinomas harbored somatic KIT mutations (V560del and H697Y). In cell viability assays, the V560del mutant was associated with similar sensitivities to imatinib and sunitinib, whereas the H697Y mutant displayed greater sensitivity to sunitinib. Genomic profiling revealed distinct differences between type A to B2 thymomas versus type B3 and thymic carcinomas. Moreover, array-based comparative genomic hybridization could readily distinguish squamous cell carcinomas of the thymus versus the lung, which can often present a diagnostic challenge. CONCLUSIONS Comprehensive genomic analysis suggests that thymic carcinomas are molecularly distinct from thymomas. These data have clinical, pathologic, and therapeutic implications for the treatment of thymic malignancies.
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Affiliation(s)
- Nicolas Girard
- Human Oncology and Pathogenesis Program (HOPP, Weill Medical College of Cornell University, New York, New York, USA
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Long lasting response to the multikinase inhibitor bay 43-9006 (Sorafenib) in a heavily pretreated metastatic thymic carcinoma. J Thorac Oncol 2009; 4:773-5. [PMID: 19461405 DOI: 10.1097/jto.0b013e3181a52e25] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Metastatic thymic carcinoma is an aggressive neoplasm for which multimodal therapies are often ineffective. We describe here a heavily pretreated patient with advanced thymic carcinoma responsive to multikinases inhibitor BAY 43-9006 (Sorafenib). Of note, a hitherto unreported c-kit missense mutation on exon 17 (D820E) identified in tumor cells seems to explain the clinical response and highlight the key role of molecular analysis in predicting efficacy of targeted therapies even in thymic neoplasms.
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