Chemotherapy and Carboplatin Paclitaxel for Thymic Cancer – pro

The thymus is a small organ located in the upper/front portion of your chest, extending from the base of the throat to the front of the heart. Thymic carcinomas are divided into low-grade (better prognosis) and high-grade (worse prognosis, that is, more likely to grow and spread quickly) categories. Around 25% of people with thymic carcinoma are cured.

Low-grade thymic carcinomas include well-differentiated squamous cell, mucoepidermoid, and basaloid types. High-grade thymic carcinomas include poorly differentiated squamous cell, small cell/neuroendocrine, clear cell, anaplastic/undifferentiated, and sarcomatoid types.

Several anticancer drugs have been used in the treatment of thymomas and thymic carcinomas. However, because thymic carcinoma is a rare neoplasm, treatment with chemotherapy has not been studied systematically. Based on case reports and series, the drugs most effective when given alone are doxorubicin (Adriamycin), cisplatin, ifosfamide, and corticosteroids (prednisone). Often, these drugs are given in combination to increase their effectiveness. Combinations used to treat thymic cancer include cisplatin, doxorubicin, etoposide and cyclophosphamide, and the combination of cisplatin, doxorubicin, cyclophosphamide, and vincristine. The role of radiation, with  or without chemotherapy, is similarly undefined and reliant on case reports and series. Although there is a paucity of information, one might consider singe agents or combinaations that have been well-documented for therapy.

NCCN lists a variety of chemo combinations on p. THYM-C, 1. On p. MS-5 it recommends paclitaxel/carboplatin as having the highest reported response rate. It also specifically mentions the ADOC regimen, but cautions that it is more toxic than carbop/paclitaxel.

Lemma GL, Lee JW, Aisner SC, et al. Phase II study of carboplatin and paclitaxel in advanced thymoma and thymic carcinoma. J Clin Oncol 2011; 29:2060.

Wright CD, Choi NC, Wain JC, et al. Induction chemoradiotherapy followed by resection for locally advanced Masaoka stage III and IVA thymic tumors. Ann Thorac Surg 2008; 85:385.

Forquer JA, Rong N, Fakiris AJ, et al. Postoperative radiotherapy after surgical resection of thymoma: differing roles in localized and regional disease. Int J Radiat Oncol Biol Phys 2010; 76:440.

A. Kitami, T. Suzuki, Y. Kamio, and S. Suzuki
Chemotherapy of Thymic Carcinoma: Analysis of Seven Cases and Review of the Literature
Jpn. J. Clin. Oncol., December 1, 2001; 31(12): 601 – 604.

M. A. Greene and M. A. Malias
Aggressive multimodality treatment of invasive thymic carcinoma
J. Thorac. Cardiovasc. Surg., February 1, 2003; 125(2): 434 – 436.

NCCN, Thymoma and Thymic cancer, 2012

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