Abstract 538P
Background
Thymic carcinoma (TC) is a rare, aggressive cancer without a standardized therapeutic approach in the metastatic context. Recently TCs have been shown to express PD-L1 and respond to single agent immunotherapy. However, small phase II studies have suggested that there may be an increase in severe adverse events. We investigated the role of chemoimmunotherapy (CIO) in a cohort of TC patients in the first line (1L) setting.
Methods
Patient data was retrospectively extracted from the Australian Registry and biObank of thoRAcic cancers (AURORA). Descriptive statistics was used for reports on efficacy and safety. Kaplan Meier analysis was used for overall survival (OS) estimates.
Results
Among 22 TC patients, 17 (77%) with metastatic disease from 3 hospitals were included in this analysis: 9 male, median age 67 years (Q1-Q3 52-72), median follow-up 23.6 months (11.8-39.0), squamous histology (SCC) 11 (65%). Among the 14 systemically treated patients (9 SCC), 8 received standard platinum based chemotherapy and 6 CIO with pembrolizumab in combination with a platinum backbone. Of these, 5 (83%) developed immune-related adverse events (irAE), incl. hypopituitarism, adrenal insufficiency, arthralgia, pneumonitis and skin toxicity. Pneumonitis was the only severe (≥G3) toxicity. No cardiac or neurological irAEs were reported. The objective response rate (ORR) was 50% in the chemo-only group and 67% in the CIO arm. In the CIO group 3 achieved a complete response (CR), 1 a partial response (PR), 1 stable disease (SD) and 1 progressive disease (PD). While 1 of the CR patients achieved remission with CIO alone, the other 2 received additional surgery or SBRT for oligoprogression and have remained in CR thereafter. The median number of pembrolizumab cycles was 17, 2 patients completed 2 years. The median duration of chemo-only response was 9.3 months (2.4 – 17.1) and of CIO response 8.1 months (2.5 – 14.8). Median OS in the chemo-only group was 32.3 months and not reached for the CIO group, with a median follow-up of 24.8 months (13.9-29.2).
Conclusions
CIO is a feasible first line treatment option in metastatic TC. Despite the high frequency of irAEs, only 1 patient had G3 or higher toxicity. With a high ORR and a subset of TC patients achieving durable responses, further studies using 1L CIO in TC are warranted.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
The authors.
Funding
Has not received any funding.
Disclosure
S.E. Bowyer: Financial Interests, Personal, Advisory Board, Cabozantinib ad board: Ipsen; Financial Interests, Personal, Advisory Board, Selpercatinib ad board: Lilly; Financial Interests, Personal, Advisory Board, Cemiplimab ad board: Sanofi; Financial Interests, Personal, Advisory Board, pembrolizumab in H&N cancer Rx: MSD; Financial Interests, Personal, Advisory Board, Neoadjuvant Rx of lung cancer: Roche; Financial Interests, Personal, Invited Speaker, neoadjuvant lung cancer Rx: BMS; Financial Interests, Personal, Invited Speaker, Immunotherapy in lung cancer: MSD; Financial Interests, Personal, Invited Speaker, Cemiplimab in Rx of advanced cutaneous SCC: Sanofi; Non-Financial Interests, Personal, Principal Investigator: BMS, GSK, Genetech, Roche, Enliven Therapeutics Inc, FLX Bio, Lilly, Hummingbird Bioscience, WMBIO, Regeneron, Janssen, ALX Oncology, Replimmune. L. Warburton: Financial Interests, Personal, Advisory Board: Roche, Novartis, MSD, AstraZeneca, BMS. B. Solomon: Financial Interests, Institutional, Advisory Board: AstraZeneca, Novartis, Merck, Bristol Myers Squibb; Financial Interests, Personal, Invited Speaker: Pfizer, AstraZeneca, Roche/Genentech; Financial Interests, Personal, Advisory Board: Amgen, Roche-Genentech, Eli Lilly, Takeda, Janssen; Financial Interests, Personal, Full or part-time Employment, Employed as a consultant Medical Oncologist at Peter MacCallum Cancer Centre: Peter MacCallum Cancer Centre; Financial Interests, Personal, Member of Board of Directors: Cancer Council of Victoria, Thoracic Oncology Group of Australasia; Financial Interests, Personal, Royalties: UpToDate; Financial Interests, Institutional, Steering Committee Member, Principal Investigator and Steering committee Chair: Roche/Genentech, Pfizer; Financial Interests, Institutional, Steering Committee Member: Novartis. T. John: Financial Interests, Personal, Invited Speaker, Speaker tour Vietnam: AstraZeneca; Financial Interests, Personal, Invited Speaker, CTIO: Merck Sharp Dohme; Financial Interests, Personal, Advisory Board: BMS, AstraZeneca, Bayer, Specialised Therapeutics; Financial Interests, Institutional, Advisory Board: Roche, Novartis, Pfizer, Amgen, Takeda, PharmaMar; Financial Interests, Personal, Other, Speaker/Chair: ACE Oncology. All other authors have declared no conflicts of interest.
Resources from the same session
451P - The real-world efficacy and safety of anamorelin hydrochloride for Japanese unresectable non-small cell lung cancer patients with cachexia
Presenter: Daisuke Arai
Session: Poster Display
Resources:
Abstract
452P - The relationship between BCG immunotherapy and oxidative stress parameters in patients with non-muscle invasive bladder cancer
Presenter: Mukul Singh
Session: Poster Display
Resources:
Abstract
453P - Palonosetron plus megestrol acetate verses palonosetron plus dexamethasone in preventing moderately emetogenic chemotherapy-induced nausea and vomiting: A randomized, multicenter, crossover, phase II trial
Presenter: Qiaoqi Li
Session: Poster Display
Resources:
Abstract
454P - A multicenter randomized open-label phase II study investigating optimal antiemetic therapy for patients with advanced/recurrent gastric cancer treated with trastuzumab deruxtecan (T-DXd): EN-hance study
Presenter: Akira Ooki
Session: Poster Display
Resources:
Abstract
455P - Assessing model-predicted neurokinin-1 (NK1) receptor occupancy (RO) of netupitant to support efficacy over an extended time period
Presenter: Matti Aapro
Session: Poster Display
Resources:
Abstract
456P - Oxycodone/naloxone in moderate-to-severe cancer pain: A phase III study in China
Presenter: Ping Lu
Session: Poster Display
Resources:
Abstract
457P - Anticoagulation for terminal cancer patients with cancer associated venous thromboembolism
Presenter: Sang Bo Oh
Session: Poster Display
Resources:
Abstract
458P - Association between TSPAN15 and SLC44A2 genetic polymorphisms and venous thromboembolism in cancer patients
Presenter: Alshimaa Al Hanafy
Session: Poster Display
Resources:
Abstract
459P - Association between national health screening program and undertreatment of dyslipidemia in cancer survivors: A cross-sectional study
Presenter: Sujeong Shin
Session: Poster Display
Resources:
Abstract
460P - Group to grow: A systematic review of group-based interventions for post-traumatic growth on cancer patients
Presenter: Dyta William
Session: Poster Display
Resources:
Abstract