Abstract 1635P
Background
Thymic carcinoma is a rare cancer with a poor prognosis in unresectable cases. There is no established standard chemotherapy for the treatment of thymic carcinoma because evidence has been obtained in single-arm trials with a small number of patients. In clinical practice, carboplatin +paclitaxel (CP), S-1 (oral fluorouracil), sunitinib, and lenvatinib have been used in Japan. However, the clinical impact of these chemotherapy regimens remains unclear. In addition, some patients receiving these treatments experience only increased liver metastases.
Methods
We retrospectively analyzed patients with metastatic or recurrent thymic carcinoma who were treated with any line of chemotherapy between 2006 and 2022 at the National Cancer Center Hospital (Tokyo, Japan), with a special focus on the CP, S-1, sunitinib, and lenvatinib regimens. The clinical outcomes (progression-free survival, PFS; objective response rate, ORR; disease control rate, DCR; liver metastasis response rate, LMRR) of the four treatment regimens were analyzed.
Results
A total of 162 patients (median age 59 years) were evaluated. Of all patients, 38 had stage Iva (23.5%), 89 had stage IVb (54.9%), and 35 had recurrent carcinoma (21.6%). A total of 142 patients had squamous cell carcinoma (87.7%), and 39 patients had liver metastases (24.1%). The most commonly administered treatments were CP (121 / 137, 89.8%) as 1st line, S-1 (73 / 109, 63.5%) as 2nd line, and sunitinib (26 / 74, 32.9%) for 3rd line therapy. The median PFS was 6.7 months in CP (95% CI, 1.4 to 25.8), 4.1 months in S-1 (95% CI, 0.5 to 41.0), 3.4 months in sunitinib (95% CI, 0.7 to 34.1), and 8.3 months in lenvatinib (95% CI, 2.5 to 36.0). The ORR, DCR and LMRR were 41.6%, 90.4%, 42.9% in CP; 24.4%, 61.6%, 30.8% in S-1; 38.7%, 93.5%, 21.4% in lenvatinib; and 22.9%, 57.2%,18.2% in sunitinib, respectively.
Conclusions
This study is one of the largest single-institute retrospective report of patients with metastatic or recurrent thymic carcinomas. CP was generally used as 1st line treatment, and the clinical outcomes were as beneficial to those in previous reports. Lenvatinib showed a satisfactory clinical outcome, even when reflecting on clinical practice, and S-1 and sunitinib showed moderate efficacies.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
The authors.
Funding
Has not received any funding.
Disclosure
Y. Okuma: Financial Interests, Personal, Invited Speaker: Astra Zenca, K. K., Nippon Boehringer Ingelheim, Chugai Phamaceutical Co., Ltd., Eli Lilly K. K., Ono Pharmaceutical Co., Ltd., Taiho Pharmacuetical Co., Ltd., Takeda Pharmacuetical Co., Ltd., Pfizer Japan Inc., AbbVie, G.K., Chugai Co., Ltd.. Y. Goto: Financial Interests, Personal, Advisory Board: AstraZeneca, Boehringer Ingelheim, Bristol Myers Squibb, Chugai, Daiichi Sankyo, Eli Lilly, Guardant Health Inc., Illumina, MSD, Novartis, Ono Pharmaceutical, Pfizer, Taiho, Johnson and Johnson, D3bio; Financial Interests, Personal, Invited Speaker: AstraZeneca, Boehringer Ingelheim, Bristol Myers Squibb, Chugai, Daiichi Sankyo, Eli Lilly, Merck, MSD, Novartis, Ono Pharmaceutical, Thermo Fischer, Pfizer, Taiho; Financial Interests, Institutional, Invited Speaker: Bristol Myers Squibb, Daiichi Sankyo, Eli Lilly, Guardant Health, Preferred Network; Financial Interests, Personal and Institutional, Invited Speaker: Chugai, Novartis, Pfizer; Financial Interests, Institutional, Research Grant: Prefered Network. Y. Shinno: Financial Interests, Institutional, Invited Speaker: BMS, Chugai, AstraZeneca, Eli Lilly, Ono; Financial Interests, Institutional, Research Grant: Ono, Janssen, Japan Clinical Research Operations K.K.. T. Yoshida: Financial Interests, Personal, Advisory Role: MSD, AstraZeneca, Novartis, Amgen, Chugai; Financial Interests, Personal, Invited Speaker: AstraZeneca, Taiho, Chugai, Novartis, Lilly, MSD, Ono, Roche, ArcherDX, BMS; Financial Interests, Institutional, Research Grant: Amgen, AstraZeneca, Takeda, Daiichi Sankyo, Ono, MSD, AbbVie, Novartis, Chugai, BMS. H. Horinouchi: Financial Interests, Personal, Invited Speaker: AstraZeneca, Eli Lilly, BMS/Ono, Merck Sharp & Dohme, Roche/Chugai, Novartis, Pfizer, Boehringer Ingelheim, Kyowa-Kirin, Nihon Kayaku, AbbVie, Roche/Chugai; Financial Interests, Personal, Advisory Board: AstraZeneca, Eli Lilly, BMS/Ono, Merck Sharp & Dohme, Roche/Chugai, Amgen, Nihon Kayaku; Financial Interests, Institutional, Research Grant: Roche/Chugai, Merck Sharp & Dohme, Daiichi-Sankyo, Ono Pharmaceutical, AstraZeneca; Financial Interests, Institutional, Invited Speaker: AbbVie. N. Yamamoto: Financial Interests, Institutional, Research Grant: Astellas, AstraZeneca, Chugai, Eisai, Taiho, BMS, Pfizer, Novartis, Eli Lilly, AbbVie, Daiichi-Sankyo, Bayer, Boehringer Ingelheim, Kyowa-Hokko Kirin, Takeda, Ono, Janssen Pharma, MSD, Merck, GSK, Sumitomo Dainippon, Chiome Bioscience, Otsuka, Carna, Biosciences, Genmab, Shionogi; Financial Interests, Personal, Advisory Role: Eisai, Takeda, Otsuka, Boehringer Ingelheim, Cimic, Chugai; Financial Interests, Personal, Invited Speaker: AstraZeneca, Eli Lilly, Ono, Chugai, Sysmex, Daiichi-Sankyo, Eisai. Y. Ohe: Financial Interests, Personal, Invited Speaker: AstraZeneca, Chugai, Ono, BMS, Eli Lilly, Boehringer Ingelheim, Takeda, MSD, Novartis; Financial Interests, Personal, Advisory Board: AstraZaneca, BMS, Celltrion, Amgen, Nippon Kayaku, Takeda, Pfizer, Ono, Janssen, AnHeart Therapeutics Inc; Financial Interests, Institutional, Invited Speaker: AstraZeneca, Eli Lilly, Janssen, Amgen; Financial Interests, Personal and Institutional, Invited Speaker: Takeda, Ono; Non-Financial Interests, Leadership Role: JSMO, JLCS, JCOG; Non-Financial Interests, Member: ASCO. All other authors have declared no conflicts of interest.