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Treatment outcomes and prognosis of immune checkpoint inhibitors therapy in patients with advanced thymic carcinoma: A multicentre retrospective study

  • Author Footnotes
    1 These authors contributed equally to this work.
    Wenxian Wang
    Footnotes
    1 These authors contributed equally to this work.
    Affiliations
    Department of Medical Oncology, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou, China

    Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Hangzhou, China
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  • Author Footnotes
    1 These authors contributed equally to this work.
    Gen Lin
    Footnotes
    1 These authors contributed equally to this work.
    Affiliations
    Department of Thoracic Oncology, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou, China
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  • Author Footnotes
    1 These authors contributed equally to this work.
    Yue Hao
    Footnotes
    1 These authors contributed equally to this work.
    Affiliations
    Department of Medical Oncology, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou, China
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  • Author Footnotes
    1 These authors contributed equally to this work.
    Yelan Guan
    Footnotes
    1 These authors contributed equally to this work.
    Affiliations
    Department of Medical Oncology, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou, China
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  • Yuxin Zhang
    Affiliations
    Department of Radiotherapy, Hangzhou Cancer Hospital, Hangzhou, China
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  • Chunwei Xu
    Affiliations
    Department of Respiratory Medicine, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
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  • Qian Wang
    Affiliations
    Department of Respiratory Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Province Hospital of Chinese Medicine, Nanjing, China
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  • Dong Wang
    Affiliations
    Department of Respiratory Medicine, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
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  • Zhansheng Jiang
    Affiliations
    Department of Integrative Oncology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer; Key Laboratory of Cancer Prevention and Therapy, Tianjin, China
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  • Jing Cai
    Affiliations
    Department of Oncology, Second Affiliated Hospital of Nanchang University, Nanchang, China
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  • Guangyuan Lou
    Affiliations
    Department of Medical Oncology, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou, China

    Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Hangzhou, China
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  • Zhengbo Song
    Correspondence
    Corresponding author: Department of Medical Oncology, Chinese Academy of Sciences University Cancer Hospital (Zhejiang Cancer Hospital), No.1 Banshan East Street, Gongshu District, Hangzhou, 310022, China.
    Affiliations
    Department of Medical Oncology, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou, China

    Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Hangzhou, China
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  • Yongchang Zhang
    Correspondence
    Corresponding author: Department of Medical Oncology, Lung Cancer and Gastrointestinal Unit, Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, No. 283 Tongzipo Road, Changsha, 410013 China.
    Affiliations
    Department of Medical Oncology, Lung Cancer and Gastrointestinal Unit, Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
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  • Author Footnotes
    1 These authors contributed equally to this work.
Published:August 13, 2022DOI:https://doi.org/10.1016/j.ejca.2022.06.059

      Highlights

      • Immunotherapy is effective in advanced thymic carcinoma.
      • Immunochemotherapy was associated with better efficacy compared to immune checkpoint inhibitors monotherapy.
      • Immunochemotherapy as first line treatments may be a good treatment choice.
      • Liver or brain metastasis was a poor prognostic factor of mPFS in immune checkpoint inhibitors monotherapy.

      Abstract

      Background

      Immunotherapy has demonstrated good efficacy and survival outcomes in solid tumours. However, efficacy data for immune checkpoint inhibitors (ICIs) in advanced thymic carcinoma are lacking. The present study aimed to assess the activity of ICIs in advanced thymic carcinoma.

      Methods

      A multicentre retrospective study was conducted to explore the efficacy and safety of ICIs for advanced thymic carcinoma. Objective response rate (ORR), progression-free survival (PFS), overall survival, and immune-related adverse events (irAEs) were analysed. In addition, factors independently associated with treatment efficacy and survival outcomes were evaluated.

      Results

      A total of 77 patients with advanced thymic carcinoma were enrolled between March 2016 and September 2021. The ORR was existing the difference between ICIs monotherapy (n = 23) and ICIs combined with chemotherapy (n = 54) (17.4% versus 44.4%, P = 0.024). The ICIs combination treatments were associated with better median PFS (mPFS) compared to ICIs monotherapy (12.7 months versus 2.1 months, P < 0.001). Notably, liver or brain metastasis was a poor prognostic factor of mPFS (1.8 months versus 3.5 months, P = 0.012) in the ICIs monotherapy group. In addition, mPFS for the first-line treatment (n = 27) was longer than that for ICIs as the second- or posterior-line treatment (n = 50) (P < 0.001). The incidence of irAEs was 54.5% (42/77) in the 77 enrolled patients. The incidence of grade 3–4 irAE was 15.6% (12/77).

      Conclusions

      Immunotherapy is effective in advanced thymic carcinoma, especially for combination with chemotherapy showed promising antitumour activity, which indicates worthy of combination treatment strategy for further study. IrAEs also require close monitoring and management.

      Keywords

      Abbreviations:

      PD-1 (Anti-programmed death-1)
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