- •Immune checkpoint blockers strategy is feasible in pre-treated thymic carcinomas.
- •In this population, ICB achieve a RR of 18% and one-year OS of 67%.
- •Close monitoring of patients is strongly advised to detect severe immune-toxicity.
For patients with advanced thymic epithelial tumours (TET), there is no standard second-line treatment after platinum-based chemotherapy. Although immune checkpoint blockers (ICB) are a potential treatment strategy, their efficacy seems limited with an increased risk of immune-related adverse events (ir-AEs), thus hampering their application in daily clinical practice.
We performed a meta-analysis to better evaluate the existing evidence about the activity and safety of ICB in the setting of unresectable or metastatic advanced TET previously treated with platinum-based chemotherapy.
Six phase I/II trials met the eligibility criteria including a total of 166 evaluable patients (77% thymic carcinoma, 23% thymoma) evaluable for activity after being treated with pembrolizumab, nivolumab, avelumab or atezolizumab. The overall response rate to ICB was 18.4% (95% CI: 12.3–26.5), and the one-year progression-free survival rate and one-year overall survival rate were 26.0% (95% CI: 19.6–34.6) and 66.9% (95% CI: 59.6–75.2%), respectively. The incidence of grade 3–5 ir-AEs was 26.4%, with 17.1% in thymic carcinoma and 58.3% in thymoma.
Despite the absence of a robust demonstration of efficacy in the context of randomised trials, our results suggest ICB as a potential strategy in patients with pretreated TET, mainly among patients with thymic carcinoma. Close monitoring is strongly advised to detect severe immune-toxicity.
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Published online: December 31, 2022
Accepted: December 5, 2022
Received in revised form: November 24, 2022
Received: October 13, 2022
© 2022 Elsevier Ltd. All rights reserved.