Clinical Outcomes of Second-Line Chemotherapy in Patients with Previously Treated Advanced Thymic Carcinoma: A Retrospective Analysis of 191 Patients from the NEJ023 Study

Kazunari Tateishi; Ryo Ko; Takehito Shukuya; Yusuke Okuma; Satoshi Watanabe; Shoichi Kuyama; Kyoko Murase; Yoko Tsukita; Hironori Ashinuma; Taku Nakagawa; Kazutsugu Uematsu; Mika Nakao; Yoshiaki Mori; Kyoichi Kaira; Atsuto Mouri; Takao Miyabayashi; Hiroyuki Sakashita; Yoko Matsumoto; Tomoyuki Tanigawa; Tomonobu Koizumi; Satoshi Morita; Kunihiko Kobayashi; Toshihiro Nukiwa; Kazuhisa Takahashi; North East Japan Study Group

doi:10.1634/theoncologist.2019-0593

Clinical Outcomes of Second-Line Chemotherapy in Patients with Previously Treated Advanced Thymic Carcinoma: A Retrospective Analysis of 191 Patients from the NEJ023 Study

Oncologist. 2020 Apr;25(4):e668-e674. doi: 10.1634/theoncologist.2019-0593. Epub 2019 Nov 26.

Authors

Kazunari Tateishi¹, Ryo Ko², Takehito Shukuya², Yusuke Okuma³, Satoshi Watanabe⁴, Shoichi Kuyama⁵, Kyoko Murase⁶, Yoko Tsukita⁷, Hironori Ashinuma⁸, Taku Nakagawa⁹, Kazutsugu Uematsu¹⁰, Mika Nakao¹¹, Yoshiaki Mori¹², Kyoichi Kaira^{13

14}, Atsuto Mouri^{14

15}, Takao Miyabayashi¹⁶, Hiroyuki Sakashita¹⁷, Yoko Matsumoto¹⁸, Tomoyuki Tanigawa¹⁹, Tomonobu Koizumi²⁰, Satoshi Morita²¹, Kunihiko Kobayashi¹⁴, Toshihiro Nukiwa²², Kazuhisa Takahashi²; North East Japan Study Group

Affiliations

¹ First Department of Internal Medicine, Shinshu University School of Medicine, Matsumoto, Japan.
² Department of Respiratory Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan.
³ Department of Thoracic Oncology and Respiratory Medicine, Tokyo Metropolitan Cancer and Infectious Disease Center Komagome Hospital, Tokyo, Japan.
⁴ Department of Respiratory Medicine and Infectious Diseases, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan.
⁵ Department of Respiratory Medicine, National Hospital Organization Iwakuni Clinical Center, Iwakuni, Japan.
⁶ Department of Respiratory Medicine, Toranomon Hospital, Tokyo, Japan.
⁷ Department of Respiratory Medicine, Miyagi Cancer Center, Natori, Japan.
⁸ Division of Respiratory Medicine, Chiba Cancer Center, Chiba, Japan.
⁹ Department of Thoracic Surgery, Omagari Kosei Medical Center, Daisen, Japan.
¹⁰ Department of Pulmonary Medicine, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan.
¹¹ Department of Internal Medicine, Division of Medical Oncology & Respiratory Medicine, Shimane University Faculty of Medicine, Izumo, Japan.
¹² Department of Respiratory Medicine, Iwate Prefectural Central Hospital, Morioka, Japan.
¹³ Department of Innovative Immune-Oncology Therapeutics, Gunma University Graduate School of Medicine, Maebashi, Japan.
¹⁴ Department of Respiratory Medicine, Saitama Medical University International Medical Center, Hidaka, Japan.
¹⁵ Department of Pulmonary Medicine, National Hospital Organization Disaster Medical Center, Tachikawa, Japan.
¹⁶ Department of Respiratory Medicine, Niigata City General Hospital, Niigata, Japan.
¹⁷ Department of Respiratory Medicine, Tokyo Medical and Dental University, Tokyo, Japan.
¹⁸ Division of Respirology, NTT Medical Center Tokyo, Tokyo, Japan.
¹⁹ Division of Pulmonary Medicine, Thoracic Center, St. Luke's International Hospital, Tokyo, Japan.
²⁰ Department of Comprehensive Cancer Therapy, Shinshu University School of Medicine, Matsumoto, Japan.
²¹ Department of Biomedical Statistics and Bioinformatics, Kyoto University Graduate School of Medicine, Kyoto, Japan.
²² Professor Emeritus, Tohoku University, Sendai, Japan.

Abstract

Background: Owing to the rarity of this tumor, there is limited information about second-line chemotherapy for patients with previously treated advanced thymic carcinoma.

Material and methods: We performed a multi-institutional, retrospective study named NEJ023 for patients with advanced thymic carcinoma. Patients without indications for curative treatment were treated with chemotherapy from 1995 to 2014 at 40 institutions in the North East Japan Study Group. Demographic and clinicopathologic characteristics, data on treatment methods, and outcomes of second-line chemotherapy were obtained from medical records.

Results: In total, 191 patients were enrolled in this study. Second-line chemotherapy included platinum-based doublets in 57.6% of patients, other multidrug chemotherapy (e.g., cisplatin, doxorubicin, vincristine, and cyclophosphamide) in 13.6%, and monotherapy in 28.8%. The median follow-up time was 50.5 months, and the median overall survival (OS) from the start of second-line chemotherapy was 22.4 (95% confidence interval, 17.5-26.7) months. The average response rate (RR) was 20.0% overall; it was 21.6% for patients treated with platinum-based doublet chemotherapy, 13.6% for those treated with other multidrug chemotherapy, and 19.6% for those treated with single agent chemotherapy. There was no significant difference in OS between platinum-based doublet chemotherapy, other multidrug chemotherapy, and monotherapy (the median OS was 22.4, 25.7, and 21.4 months, respectively).

Conclusion: The median OS was 22.4 months in patients with advanced thymic carcinoma treated with second-line chemotherapy. There were no significant differences in RR and OS between monotherapy and multidrug chemotherapy in this study.

Implications for practice: Owing to the rarity of this tumor, there is limited information about second-line chemotherapy for patients with previously treated advanced thymic carcinoma. This is the largest data for those patients treated with second-line chemotherapy. This study suggests there is no significant difference in efficacy between monotherapy and multidrug chemotherapy for previously treated advanced thymic carcinoma. This result can support the adequacy to select monotherapy as treatment of those patients.

Keywords: Platinum-based doublet chemotherapy; S-1; Second-line chemotherapy; Thymic carcinoma.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Antineoplastic Combined Chemotherapy Protocols / therapeutic use
Cisplatin / therapeutic use
Humans
Japan
Retrospective Studies
Thymoma* / drug therapy
Thymus Neoplasms* / drug therapy
Treatment Outcome

Substances

Cisplatin