Highlights
- •Co-occurrence of thymic carcinoma and Lynch syndrome.
- •MSI and thymic carcinoma.
- •Thymic carcinoma and immunotherapy.
Abstract
Importance
Thymic carcinoma (TC) is a rare aggressive tumour occurring in adults characterised
by one of the lowest tumor mutational burdens (TMB). Microsatellite instability (MSI)
is a mutational signature, caused by defects in the DNA MisMatch Repair (MMR) system,
that predicts benefit from immunotherapy and causes high TMB. Fragmentary and unstructured
evidence of these conditions co-occurring are reported in literature.
Objective
Review available data on the co-occurrence of these two conditions and determine its
frequency in our institute case series.
Design
We performed a systematic analysis of literature and a retrospective evaluation of
all the cases of TET treated at our institution from 2000 to 2020, selecting patients
with a medical history of multiple tumours to enhance a priori probability of identifying
cases with underlying predisposition.
Results
Literature yielded 3 cases of patients with MSI TC, for which MMR gene alteration
was reported. None of them received immunotherapy. Of 366 patients with TETs treated
in our institute, 32 had a medical history of multiple tumours and 25 of 32 (19 thymomas
and 6 TCs) had available tissue for MMR analysis. One patient with TC showed a high
TMB, and MSI due to MLH1 mutation and was treated in a phase II study with avelumab
and axitinib combination obtaining a long-lasting partial response. MLH1 alterations
are shared across MSI TC cases.
Conclusions and relevance
This analysis highlights the usefulness of MSI testing in patients with TC. The observation
of cases of TC occurring in patients with Lynch syndrome and the unexpected homogeneity
of gene alterations support further investigation.
Keywords
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Article info
Publication history
Published online: June 20, 2021
Accepted:
May 20,
2021
Received in revised form:
May 12,
2021
Received:
March 22,
2021
Identification
Copyright
© 2021 Elsevier Ltd. All rights reserved.
