Revision as of 23:47, 28 February 2023

14 regimens on this page 16 variants on this page

Guidelines

ESMO

2015: Girard et al. Thymic epithelial tumours: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up

NCCN

NCCN Guidelines - Thymomas and Thymic Carcinomas

Neoadjuvant therapy for borderline resectable disease

PAC

PAC: Platinol (Cisplatin), Adriamycin (Doxorubicin), Cyclophosphamide
CAP: Cyclophosphamide, Adriamycin (Doxorubicin), Platinol (Cisplatin)

Regimen

Study	Evidence
Kim et al. 2004	Phase 2

Note: while this regimen is conventionally referred to as PAC or CAP, it also includes a high-dose prednisone component with likely antineoplastic properties.

Chemotherapy

Cisplatin (Platinol) 30 mg/m² IV once per day on days 1 to 3
Doxorubicin (Adriamycin) 20 mg/m²/day IV continuous infusion over 72 hours, started on day 1 (total dose per cycle: 60 mg/m²)
Cyclophosphamide (Cytoxan) 500 mg/m² IV slow push once on day 1

Glucocorticoid therapy

Prednisone (Sterapred) 100 mg PO once per day on days 1 to 5

Supportive therapy

Metoclopramide (Reglan) 1 mg/kg IV once per day on days 1 to 3, prior to chemotherapy
Diphenhydramine (Benadryl) 25 mg IV once per day on days 1 to 3, prior to chemotherapy

21- to 28-day cycle for 3 cycles

Subsequent treatment

Surgical resection is performed if CT scan 3 to 4 weeks after the third cycle of chemotherapy shows disease amenable to resection, and is followed by RT, then PAC consolidation

References

Kim ES, Putnam JB, Komaki R, Walsh GL, Ro JY, Shin HJ, Truong M, Moon H, Swisher SG, Fossella FV, Khuri FR, Hong WK, Shin DM. Phase II study of a multidisciplinary approach with induction chemotherapy, followed by surgical resection, radiation therapy, and consolidation chemotherapy for unresectable malignant thymomas: final report. Lung Cancer. 2004 Jun;44(3):369-79. link to original article contains dosing details in manuscript PubMed

Adjuvant therapy

PAC

PAC: Platinol (Cisplatin), Adriamycin (Doxorubicin), Cyclophosphamide
CAP: Cyclophosphamide, Adriamycin (Doxorubicin), Platinol (Cisplatin)

Regimen

Study	Evidence
Kim et al. 2004	Phase 2

Note: while this regimen is conventionally referred to as PAC or CAP, it also includes a high-dose prednisone component with likely antineoplastic properties. Also note that these doses are 80% of the induction doses, except for the prednisone.

Preceding treatment

RT

Chemotherapy

Cisplatin (Platinol) 24 mg/m² IV once per day on days 1 to 3
Doxorubicin (Adriamycin) 16 mg/m²/day IV continuous infusion over 72 hours, started on day 1 (total dose per cycle: 48 mg/m²)
Cyclophosphamide (Cytoxan) 400 mg/m² IV slow push once on day 1

Glucocorticoid therapy

Prednisone (Sterapred) 100 mg PO once per day on days 1 to 5

21- to 28-day cycle for 3 cycles

References

Kim ES, Putnam JB, Komaki R, Walsh GL, Ro JY, Shin HJ, Truong M, Moon H, Swisher SG, Fossella FV, Khuri FR, Hong WK, Shin DM. Phase II study of a multidisciplinary approach with induction chemotherapy, followed by surgical resection, radiation therapy, and consolidation chemotherapy for unresectable malignant thymomas: final report. Lung Cancer. 2004 Jun;44(3):369-79. link to original article contains dosing details in manuscript PubMed

Radiation therapy

Regimen

Study	Evidence
Kim et al. 2004	Phase 2

Preceding treatment

PAC induction, then surgery (in some cases)

Radiotherapy

If tumor is completely resected and has at least 80% necrosis: 50 Gy External beam radiotherapy is administered 3 to 6 weeks after surgery
If tumor is incompletely resected or has less than 80% necrosis: 60 Gy External beam radiotherapy is administered

One course

Subsequent treatment

PAC x 3

References

Kim ES, Putnam JB, Komaki R, Walsh GL, Ro JY, Shin HJ, Truong M, Moon H, Swisher SG, Fossella FV, Khuri FR, Hong WK, Shin DM. Phase II study of a multidisciplinary approach with induction chemotherapy, followed by surgical resection, radiation therapy, and consolidation chemotherapy for unresectable malignant thymomas: final report. Lung Cancer. 2004 Jun;44(3):369-79. link to original article contains dosing details in manuscript PubMed

Advanced or metastatic disease, first-line therapy

ADOC

ADOC: Adriamycin (Doxorubicin), cis-Diamminedichloroplatinum (Cisplatin), Oncovin (Vincristine), Cyclophosphamide

Regimen

Study	Evidence
Fornasiero et al. 1991	Retrospective

Note: The body of Fornasiero et al. 1991 specifies that cycles are given every 3 weeks. However, the abstract says that cycles are given "at monthly intervals," and some guidelines list the regimen as being given every 4 weeks.

Chemotherapy

Doxorubicin (Adriamycin) 40 mg/m² IV once on day 1
Cisplatin (Platinol) 50 mg/m² IV once on day 1
Vincristine (Oncovin) 0.6 mg/m² IV once on day 3
Cyclophosphamide (Cytoxan) 700 mg/m² IV once on day 4

21- to 28-day cycles

References

Retrospective: Fornasiero A, Daniele O, Ghiotto C, Piazza M, Fiore-Donati L, Calabró F, Rea F, Fiorentino MV. Chemotherapy for invasive thymoma. A 13-year experience. Cancer. 1991 Jul 1;68(1):30-3. link to original article contains dosing details in manuscript PubMed

Carboplatin & Paclitaxel (CP)

Regimen

Study	Evidence
Lemma et al. 2011	Phase 2

Chemotherapy

Carboplatin (Paraplatin) AUC 6 IV over 30 minutes once on day 1, given second
Paclitaxel (Taxol) 225 mg/m² IV over 3 hours once on day 1, given first

Supportive therapy

Cimetidine (Tagamet) 300 mg IV once on day 1; 60 minutes prior to Paclitaxel (Taxol)
Diphenhydramine (Benadryl) 25 mg IV once on day 1; 60 minutes prior to Paclitaxel (Taxol)
Dexamethasone (Decadron) 20 mg IV once on day 1; 60 minutes prior to Paclitaxel (Taxol)

21-day cycle for up to 6 cycles

References

Lemma GL, Lee JW, Aisner SC, Langer CJ, Tester WJ, Johnson DH, Loehrer PJ Sr. Phase II study of carboplatin and paclitaxel in advanced thymoma and thymic carcinoma. J Clin Oncol. 2011 May 20;29(15):2060-5. Epub 2011 Apr 18. link to original article contains dosing details in manuscript link to PMC article PubMed

Cisplatin & Etoposide (EP)

PE: Platinol (Cisplatin), Etoposide

Regimen

Study	Evidence
Giaccone et al. 1996	Phase 2

Chemotherapy

Cisplatin (Platinol) 60 mg/m² IV over 60 minutes once on day 1
Etoposide (Vepesid) 120 mg/m² IV over at least 30 minutes once per day on days 1 to 3

Supportive therapy

"A program of forced hydration"

21-day cycle for up to 8 cycles

References

Giaccone G, Ardizzoni A, Kirkpatrick A, Clerico M, Sahmoud T, van Zandwijk N; EORTC Lung Cancer Cooperative Group. Cisplatin and etoposide combination chemotherapy for locally advanced or metastatic thymoma: a phase II study of the European Organisation for Research and Treatment of Cancer Lung Cancer Cooperative Group. J Clin Oncol. 1996 Mar;14(3):814-20. link to original article contains dosing details in manuscript PubMed

PAC

PAC: Platinol (Cisplatin), Adriamycin (Doxorubicin), Cyclophosphamide
CAP: Cyclophosphamide, Adriamycin (Doxorubicin), Platinol (Cisplatin)

Regimen

Study	Evidence
Loehrer et al. 1990	Phase 2

Chemotherapy

Cisplatin (Platinol) 50 mg/m² IV over at least 1 hour once on day 1
Doxorubicin (Adriamycin) 50 mg/m² IV slow push once on day 1
Cyclophosphamide (Cytoxan) 500 mg/m² IV slow push once on day 1

Supportive therapy

1 liter NS over 2 hours at least 2 hours before and after Cisplatin (Platinol) therapy
Corticosteroids use for antiemesis was specifically discouraged unless the indication was for myasthenia gravis

21-day cycle for up to 8 cycles

References

Loehrer PJ Sr, Perez CA, Roth LM, Greco A, Livingston RB, Einhorn LH. Chemotherapy for advanced thymoma: preliminary results of an intergroup study. Ann Intern Med. 1990 Oct 1;113(7):520-4. link to original article contains dosing details in manuscript PubMed
1. Update: Loehrer PJ Sr, Kim K, Aisner SC, Livingston R, Einhorn LH, Johnson D, Blum R; Eastern Cooperative Oncology Group; Southwest Oncology Group; Southeastern Cancer Study Group. Cisplatin plus doxorubicin plus cyclophosphamide in metastatic or recurrent thymoma: final results of an intergroup trial. J Clin Oncol. 1994 Jun;12(6):1164-8. link to original article contains dosing details in manuscript PubMed

VIP

VIP: Vepesid (Etoposide), Ifosfamide, Platinol (Cisplatin)

Regimen

Study	Evidence
Loehrer et al. 2001	Phase 2

Chemotherapy

Etoposide (Vepesid) 75 mg/m² IV once per day on days 1 to 4
Ifosfamide (Ifex) 1200 mg/m² IV once per day on days 1 to 4
Cisplatin (Platinol) 20 mg/m² IV once per day on days 1 to 4

Supportive therapy

Mesna (Mesnex) 240 mg/m² IV push two times per day on days 1 to 4, given 4 hours after and 8 hours after Ifosfamide (Ifex) (total dose per cycle: 1920 mg/m²)
1 liter normal saline once per day on days 1 to 4, prior to Cisplatin (Platinol)
Filgrastim (Neupogen) 5 mcg/kg SC once per day on days 5 to 15, until WBC count at least 10 x 10⁹/L above nadir

21-day cycle for 4 cycles

References

Loehrer PJ Sr, Jiroutek M, Aisner S, Aisner J, Green M, Thomas CR Jr, Livingston R, Johnson DH. Combined etoposide, ifosfamide, and cisplatin in the treatment of patients with advanced thymoma and thymic carcinoma: an intergroup trial. Cancer. 2001 Jun 1;91(11):2010-5. link to original article contains dosing details in manuscript PubMed

Advanced or metastatic disease, subsequent lines of therapy

Capecitabine & Gemcitabine

CAP-GEM: CAPecitabine & GEMcitabine

Regimen

Study	Evidence	Efficacy
Palmieri et al. 2009	Phase 2	ORR: 40%

Chemotherapy

Capecitabine (Xeloda) 650 mg/m² PO twice per day on days 1 to 14
Gemcitabine (Gemzar) 1000 mg/m² IV once per day on days 1 & 8

21-day cycles

References

Palmieri G, Merola G, Federico P, Petillo L, Marino M, Lalle M, Milella M, Ceribelli A, Montella L, Merola C, Del Prete S, Bergaglio M, De Placido S, Di Lorenzo G. Preliminary results of phase II study of capecitabine and gemcitabine (CAP-GEM) in patients with metastatic pretreated thymic epithelial tumors (TETs). Ann Oncol. 2010 Jun;21(6):1168-72. Epub 2009 Oct 30. link to original article PubMed
1. Update: Palmieri G, Buonerba C, Ottaviano M, Federico P, Calabrese F, Von Arx C, De Maio AP, Marino M, Lalle M, Montella L, Merola C, Milella M, Bergaglio M, Di Lorenzo G, Damiano V. Capecitabine plus gemcitabine in thymic epithelial tumors: final analysis of a Phase II trial. Future Oncol. 2014 Nov;10(14):2141-7. link to original article contains dosing details in abstract PubMed

Everolimus monotherapy

Regimen

Study	Evidence	Efficacy
Zucali et al. 2017 (ONC-2010-001)	Phase 2	DCR: 88%

Targeted therapy

Everolimus (Afinitor) 10 mg PO once per day

Continued indefinitely

References

ONC-2010-001: Zucali PA, De Pas T, Palmieri G, Favaretto A, Chella A, Tiseo M, Caruso M, Simonelli M, Perrino M, De Vincenzo F, Toffalorio F, Damiano V, Pasello G, Garbella E, Ali M, Conforti F, Ottaviano M, Cioffi A, De Placido S, Giordano L, Bertossi M, Destro A, Di Tommaso L, Santoro A. Phase II study of everolimus in patients with thymoma and thymic carcinoma previously treated with cisplatin-based chemotherapy. J Clin Oncol. 2018 Feb 1;36(4):342-349. Epub 2017 Dec 14.link to original article contains dosing details in manuscript PubMed

Ifosfamide monotherapy

Regimen variant #1, intermittent dosing

Study	Evidence
Highley et al. 1999	Pilot, <20 pts

Chemotherapy

Ifosfamide (Ifex) 1500 mg/m² IV over 30 minutes once per day on days 1 to 5

Supportive therapy

Mesna (Mesnex) 400 mg IV bolus once per day on days 1 to 5, given before ifosfamide, then 1000 mg/m² IV over 7.5 hours (total dose per cycle: 7000 mg/m²)

21-day cycles

Regimen variant #2, continuous dosing

Study	Evidence
Highley et al. 1999	Pilot, <20 pts

Chemotherapy

Ifosfamide (Ifex) 1500 mg/m²/day IV continuous infusion over 120 hours, started on day 1, given second (total dose per cycle: 6000 mg/m²)

Supportive therapy

Mesna (Mesnex) 2000 mg IV bolus once on day 1, given first, then 1500 mg/m²/day IV continuous infusion over 7 days (total dose per cycle: 12,500 mg/m²)

21-day cycles

References

Highley MS, Underhill CR, Parnis FX, Karapetis C, Rankin E, Dussek J, Bryant B, Rowland C, Hodson N, Hughes J, Harper PG. Treatment of invasive thymoma with single-agent ifosfamide. J Clin Oncol. 1999 Sep;17(9):2737-44. link to original article contains dosing details in manuscript PubMed content property of HemOnc.org

Octreotide monotherapy

Regimen variant #1, brief course

Study	Evidence
Loehrer et al. 2004	Phase 2

Endocrine therapy

Octreotide (Sandostatin) 0.5 mg SC three times per day

1-month cycle for 2 cycles

Subsequent treatment

If stable disease, patients would transition to octreotide & prednisone

Regimen variant #2, extended course

Study	Evidence
Loehrer et al. 2004	Phase 2

Endocrine therapy

Octreotide (Sandostatin) 0.5 mg SC three times per day

1-month cycle for up to 12 cycles

References

Loehrer PJ Sr, Wang W, Johnson DH, Aisner SC, Ettinger DS; Eastern Cooperative Oncology Group. Octreotide alone or with prednisone in patients with advanced thymoma and thymic carcinoma: an Eastern Cooperative Oncology Group Phase II Trial. J Clin Oncol. 2004 Jan 15;22(2):293-9. link to original article contains dosing details in manuscript PubMed

Octreotide & Prednisone

Regimen

Study	Evidence
Loehrer et al. 2004	Phase 2

Preceding treatment

Octreotide x 2 mo

Endocrine therapy

Octreotide (Sandostatin) 0.5 mg SC three times per day
Prednisone (Sterapred) 0.6 mg/kg PO once per day

1-month cycle for up to 10 cycles

References

Loehrer PJ Sr, Wang W, Johnson DH, Aisner SC, Ettinger DS; Eastern Cooperative Oncology Group. Octreotide alone or with prednisone in patients with advanced thymoma and thymic carcinoma: an Eastern Cooperative Oncology Group Phase II Trial. J Clin Oncol. 2004 Jan 15;22(2):293-9. link to original article contains dosing details in manuscript PubMed

Sunitinib monotherapy

Regimen

Study	Evidence
Thomas et al. 2015 (NCI 12-C-0118)	Phase 2

Targeted therapy

Sunitinib (Sutent) 50 mg PO once per day on days 1 to 28

42-day cycles

References

NCI 12-C-0118: Thomas A, Rajan A, Berman A, Tomita Y, Brzezniak C, Lee MJ, Lee S, Ling A, Spittler AJ, Carter CA, Guha U, Wang Y, Szabo E, Meltzer P, Steinberg SM, Trepel JB, Loehrer PJ, Giaccone G. Sunitinib in patients with chemotherapy-refractory thymoma and thymic carcinoma: an open-label phase 2 trial. Lancet Oncol. 2015 Feb;16(2):177-86. Epub 2015 Jan 13. Erratum in: Lancet Oncol. 2015 Mar;16(3):e105. link to original article contains dosing details in manuscript link to PMC article PubMed NCT01621568

Investigational agents

Drugs with preliminary evidence of efficacy in this disease subtype.

Cixutumumab (IMC-A12)

@@ Line 10: / Line 10: @@
 |}
 {{TOC limit|limit=3}}
 =Guidelines=
 ==[http://www.esmo.org/ ESMO]==
 *'''2015:''' Girard et al. [https://www.esmo.org/Guidelines/Lung-and-Chest-Tumours/Thymic-Epithelial-Tumours Thymic epithelial tumours: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up]
 ==[https://www.nccn.org/ NCCN]==
 *[https://www.nccn.org/professionals/physician_gls/pdf/thymic.pdf NCCN Guidelines - Thymomas and Thymic Carcinomas]
 =Neoadjuvant therapy for borderline resectable disease=
 ==PAC {{#subobject:96fd1b|Regimen=1}}==
 PAC: '''<u>P</u>'''latinol (Cisplatin), '''<u>A</u>'''driamycin (Doxorubicin), '''<u>C</u>'''yclophosphamide<br>
 CAP: '''<u>C</u>'''yclophosphamide, '''<u>A</u>'''driamycin (Doxorubicin), '''<u>P</u>'''latinol (Cisplatin)
+<div class="toccolours" style="background-color:#eeeeee">
 ===Regimen {{#subobject:dcf948|Variant=1}}===
 {| class="wikitable" style="width: 40%; text-align:center;"
@@ Line 33: / Line 30: @@
 |}
 ''Note: while this regimen is conventionally referred to as PAC or CAP, it also includes a high-dose prednisone component with likely antineoplastic properties.''
+<div class="toccolours" style="background-color:#b3e2cd">
 ====Chemotherapy====
 *[[Cisplatin (Platinol)]] 30 mg/m<sup>2</sup> IV once per day on days 1 to 3
@@ Line 39: / Line 37: @@
 ====Glucocorticoid therapy====
 *[[Prednisone (Sterapred)]] 100 mg PO once per day on days 1 to 5
 ====Supportive therapy====
 *[[Metoclopramide (Reglan)]] 1 mg/kg IV once per day on days 1 to 3, prior to chemotherapy
 *[[Diphenhydramine (Benadryl)]] 25 mg IV once per day on days 1 to 3, prior to chemotherapy
 '''21- to 28-day cycle for 3 cycles'''
+</div>
+<div class="toccolours" style="background-color:#cbd5e7">
 ====Subsequent treatment====
 *[[Surgery#Thymectomy|Surgical resection]] is performed if CT scan 3 to 4 weeks after the third cycle of chemotherapy shows disease amenable to resection, and is followed by [[#Radiation_therapy|RT]], then [[#PAC_2|PAC]] consolidation
+</div></div>
 ===References===
 # Kim ES, Putnam JB, Komaki R, Walsh GL, Ro JY, Shin HJ, Truong M, Moon H, Swisher SG, Fossella FV, Khuri FR, Hong WK, Shin DM. Phase II study of a multidisciplinary approach with induction chemotherapy, followed by surgical resection, radiation therapy, and consolidation chemotherapy for unresectable malignant thymomas: final report. Lung Cancer. 2004 Jun;44(3):369-79. [https://doi.org/10.1016/j.lungcan.2003.12.010 link to original article] '''contains dosing details in manuscript''' [https://pubmed.ncbi.nlm.nih.gov/15140551 PubMed]
 =Adjuvant therapy=
 ==PAC {{#subobject:76239f|Regimen=1}}==
 PAC: '''<u>P</u>'''latinol (Cisplatin), '''<u>A</u>'''driamycin (Doxorubicin), '''<u>C</u>'''yclophosphamide<br>
 CAP: '''<u>C</u>'''yclophosphamide, '''<u>A</u>'''driamycin (Doxorubicin), '''<u>P</u>'''latinol (Cisplatin)
+<div class="toccolours" style="background-color:#eeeeee">
 ===Regimen {{#subobject:adbf18|Variant=1}}===
 {| class="wikitable" style="width: 40%; text-align:center;"
@@ Line 66: / Line 63: @@
 |}
 ''Note: while this regimen is conventionally referred to as PAC or CAP, it also includes a high-dose prednisone component with likely antineoplastic properties. Also note that these doses are 80% of the induction doses, except for the prednisone.''
+<div class="toccolours" style="background-color:#cbd5e8">
 ====Preceding treatment====
 *[[#Radiation_therapy|RT]]
+</div>
+<div class="toccolours" style="background-color:#b3e2cd">
 ====Chemotherapy====
 *[[Cisplatin (Platinol)]] 24 mg/m<sup>2</sup> IV once per day on days 1 to 3
@@ Line 74: / Line 74: @@
 ====Glucocorticoid therapy====
 *[[Prednisone (Sterapred)]] 100 mg PO once per day on days 1 to 5
 '''21- to 28-day cycle for 3 cycles'''
+</div></div>
 ===References===
 # Kim ES, Putnam JB, Komaki R, Walsh GL, Ro JY, Shin HJ, Truong M, Moon H, Swisher SG, Fossella FV, Khuri FR, Hong WK, Shin DM. Phase II study of a multidisciplinary approach with induction chemotherapy, followed by surgical resection, radiation therapy, and consolidation chemotherapy for unresectable malignant thymomas: final report. Lung Cancer. 2004 Jun;44(3):369-79. [https://doi.org/10.1016/j.lungcan.2003.12.010 link to original article] '''contains dosing details in manuscript''' [https://pubmed.ncbi.nlm.nih.gov/15140551 PubMed]
 ==Radiation therapy {{#subobject:afc56b|Regimen=1}}==
+<div class="toccolours" style="background-color:#eeeeee">
 ===Regimen {{#subobject:07cb87|Variant=1}}===
 {| class="wikitable" style="width: 40%; text-align:center;"
@@ Line 91: / Line 89: @@
 |-
 |}
+<div class="toccolours" style="background-color:#cbd5e8">
 ====Preceding treatment====
 *[[#PAC|PAC]] induction, then [[Surgery#Thymectomy|surgery]] (in some cases)
+</div>
+<div class="toccolours" style="background-color:#b3e2cd">
 ====Radiotherapy====
 *If tumor is completely resected and has at least 80% necrosis: 50 Gy [[External beam radiotherapy]] is administered 3 to 6 weeks after surgery
 *If tumor is incompletely resected or has less than 80% necrosis: 60 Gy [[External beam radiotherapy]] is administered
 '''One course'''
+</div>
+<div class="toccolours" style="background-color:#cbd5e7">
 ====Subsequent treatment====
 *[[#PAC_2|PAC]] x 3
+</div></div>
 ===References===
 # Kim ES, Putnam JB, Komaki R, Walsh GL, Ro JY, Shin HJ, Truong M, Moon H, Swisher SG, Fossella FV, Khuri FR, Hong WK, Shin DM. Phase II study of a multidisciplinary approach with induction chemotherapy, followed by surgical resection, radiation therapy, and consolidation chemotherapy for unresectable malignant thymomas: final report. Lung Cancer. 2004 Jun;44(3):369-79. [https://doi.org/10.1016/j.lungcan.2003.12.010 link to original article] '''contains dosing details in manuscript''' [https://pubmed.ncbi.nlm.nih.gov/15140551 PubMed]
 =Advanced or metastatic disease, first-line therapy=
 ==ADOC {{#subobject:a329b4|Regimen=1}}==
 ADOC: '''<u>A</u>'''driamycin (Doxorubicin), cis-'''<u>D</u>'''iamminedichloroplatinum (Cisplatin), '''<u>O</u>'''ncovin (Vincristine), '''<u>C</u>'''yclophosphamide
+<div class="toccolours" style="background-color:#eeeeee">
 ===Regimen {{#subobject:ee5c1b|Variant=1}}===
 {| class="wikitable" style="width: 40%; text-align:center;"
@@ Line 119: / Line 119: @@
 |}
 ''Note: The body of Fornasiero et al. 1991 specifies that cycles are given every 3 weeks. However, the abstract says that cycles are given "at monthly intervals," and some guidelines list the regimen as being given every 4 weeks.''
+<div class="toccolours" style="background-color:#b3e2cd">
 ====Chemotherapy====
 *[[Doxorubicin (Adriamycin)]] 40 mg/m<sup>2</sup> IV once on day 1
@@ Line 124: / Line 125: @@
 *[[Vincristine (Oncovin)]] 0.6 mg/m<sup>2</sup> IV once on day 3
 *[[Cyclophosphamide (Cytoxan)]] 700 mg/m<sup>2</sup> IV once on day 4
 '''21- to 28-day cycles'''
+</div></div>
 ===References===
 # '''Retrospective:''' Fornasiero A, Daniele O, Ghiotto C, Piazza M, Fiore-Donati L, Calabró F, Rea F, Fiorentino MV. Chemotherapy for invasive thymoma. A 13-year experience. Cancer. 1991 Jul 1;68(1):30-3. [https://doi.org/10.1002/1097-0142%2819910701)68:1%3C30::AID-CNCR2820680106%3E3.0.CO;2-4 link to original article] '''contains dosing details in manuscript''' [https://pubmed.ncbi.nlm.nih.gov/2049749 PubMed]
 ==Carboplatin & Paclitaxel (CP) {{#subobject:410ff6|Regimen=1}}==
+<div class="toccolours" style="background-color:#eeeeee">
 ===Regimen {{#subobject:34b20a|Variant=1}}===
 {| class="wikitable" style="width: 40%; text-align:center;"
@@ Line 141: / Line 140: @@
 |-
 |}
+<div class="toccolours" style="background-color:#b3e2cd">
 ====Chemotherapy====
 *[[Carboplatin (Paraplatin)]] AUC 6 IV over 30 minutes once on day 1, '''given second'''
 *[[Paclitaxel (Taxol)]] 225 mg/m<sup>2</sup> IV over 3 hours once on day 1, '''given first'''
 ====Supportive therapy====
 *[[Cimetidine (Tagamet)]] 300 mg IV once on day 1; 60 minutes prior to [[Paclitaxel (Taxol)]]
 *[[Diphenhydramine (Benadryl)]] 25 mg IV once on day 1; 60 minutes prior to [[Paclitaxel (Taxol)]]
 *[[Dexamethasone (Decadron)]] 20 mg IV once on day 1; 60 minutes prior to [[Paclitaxel (Taxol)]]
 '''21-day cycle for up to 6 cycles'''
+</div></div>
 ===References===
 # Lemma GL, Lee JW, Aisner SC, Langer CJ, Tester WJ, Johnson DH, Loehrer PJ Sr. Phase II study of carboplatin and paclitaxel in advanced thymoma and thymic carcinoma. J Clin Oncol. 2011 May 20;29(15):2060-5. Epub 2011 Apr 18. [https://doi.org/10.1200/jco.2010.32.9607 link to original article] '''contains dosing details in manuscript''' [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3107762/ link to PMC article] [https://pubmed.ncbi.nlm.nih.gov/21502559 PubMed]
 ==Cisplatin & Etoposide (EP) {{#subobject:2355da|Regimen=1}}==
 PE: '''<u>P</u>'''latinol (Cisplatin), '''<u>E</u>'''toposide
+<div class="toccolours" style="background-color:#eeeeee">
 ===Regimen {{#subobject:906dfc|Variant=1}}===
 {| class="wikitable" style="width: 40%; text-align:center;"
@@ Line 167: / Line 164: @@
 |-
 |}
+<div class="toccolours" style="background-color:#b3e2cd">
 ====Chemotherapy====
 *[[Cisplatin (Platinol)]] 60 mg/m<sup>2</sup> IV over 60 minutes once on day 1
 *[[Etoposide (Vepesid)]] 120 mg/m<sup>2</sup> IV over at least 30 minutes once per day on days 1 to 3
 ====Supportive therapy====
 *"A program of forced hydration"
 '''21-day cycle for up to 8 cycles'''
+</div></div>
 ===References===
 # Giaccone G, Ardizzoni A, Kirkpatrick A, Clerico M, Sahmoud T, van Zandwijk N; [[Study_Groups#EORTC|EORTC]] Lung Cancer Cooperative Group. Cisplatin and etoposide combination chemotherapy for locally advanced or metastatic thymoma: a phase II study of the European Organisation for Research and Treatment of Cancer Lung Cancer Cooperative Group. J Clin Oncol. 1996 Mar;14(3):814-20. [https://doi.org/10.1200/jco.1996.14.3.814 link to original article] '''contains dosing details in manuscript''' [https://pubmed.ncbi.nlm.nih.gov/8622029 PubMed]
 ==PAC {{#subobject:ce7f87|Regimen=1}}==
 PAC: '''<u>P</u>'''latinol (Cisplatin), '''<u>A</u>'''driamycin (Doxorubicin), '''<u>C</u>'''yclophosphamide<br>
 CAP: '''<u>C</u>'''yclophosphamide, '''<u>A</u>'''driamycin (Doxorubicin), '''<u>P</u>'''latinol (Cisplatin)
+<div class="toccolours" style="background-color:#eeeeee">
 ===Regimen {{#subobject:f15804|Variant=1}}===
 {| class="wikitable" style="width: 40%; text-align:center;"
@@ Line 192: / Line 187: @@
 |-
 |}
+<div class="toccolours" style="background-color:#b3e2cd">
 ====Chemotherapy====
 *[[Cisplatin (Platinol)]] 50 mg/m<sup>2</sup> IV over at least 1 hour once on day 1
 *[[Doxorubicin (Adriamycin)]] 50 mg/m<sup>2</sup> IV slow push once on day 1
 *[[Cyclophosphamide (Cytoxan)]] 500 mg/m<sup>2</sup> IV slow push once on day 1
 ====Supportive therapy====
 *1 liter NS over 2 hours at least 2 hours before and after [[Cisplatin (Platinol)]] therapy
 *Corticosteroids use for antiemesis was specifically discouraged unless the indication was for myasthenia gravis
 '''21-day cycle for up to 8 cycles'''
+</div></div>
 ===References===
 # Loehrer PJ Sr, Perez CA, Roth LM, Greco A, Livingston RB, Einhorn LH. Chemotherapy for advanced thymoma: preliminary results of an intergroup study. Ann Intern Med. 1990 Oct 1;113(7):520-4. [https://doi.org/10.7326/0003-4819-113-7-520 link to original article] '''contains dosing details in manuscript''' [https://pubmed.ncbi.nlm.nih.gov/2203292 PubMed]
 ## '''Update:''' Loehrer PJ Sr, Kim K, Aisner SC, Livingston R, Einhorn LH, Johnson D, Blum R; Eastern Cooperative Oncology Group; Southwest Oncology Group; Southeastern Cancer Study Group. Cisplatin plus doxorubicin plus cyclophosphamide in metastatic or recurrent thymoma: final results of an intergroup trial. J Clin Oncol. 1994 Jun;12(6):1164-8. [https://doi.org/10.1200/jco.1994.12.6.1164 link to original article] '''contains dosing details in manuscript''' [https://pubmed.ncbi.nlm.nih.gov/8201378 PubMed]
 ==VIP {{#subobject:e1d675|Regimen=1}}==
 VIP: '''<u>V</u>'''epesid (Etoposide), '''<u>I</u>'''fosfamide, '''<u>P</u>'''latinol (Cisplatin)
+<div class="toccolours" style="background-color:#eeeeee">
 ===Regimen {{#subobject:2235f2|Variant=1}}===
 {| class="wikitable" style="width: 40%; text-align:center;"
@@ Line 219: / Line 212: @@
 |-
 |}
+<div class="toccolours" style="background-color:#b3e2cd">
 ====Chemotherapy====
 *[[Etoposide (Vepesid)]] 75 mg/m<sup>2</sup> IV once per day on days 1 to 4
 *[[Ifosfamide (Ifex)]] 1200 mg/m<sup>2</sup> IV once per day on days 1 to 4
 *[[Cisplatin (Platinol)]] 20 mg/m<sup>2</sup> IV once per day on days 1 to 4
 ====Supportive therapy====
 *[[Mesna (Mesnex)]] 240 mg/m<sup>2</sup> IV push two times per day on days 1 to 4, given 4 hours after and 8 hours after [[Ifosfamide (Ifex)]] (total dose per cycle: 1920 mg/m<sup>2</sup>)
 *1 liter normal saline once per day on days 1 to 4, prior to [[Cisplatin (Platinol)]]
 *[[Filgrastim (Neupogen)]] 5 mcg/kg SC once per day on days 5 to 15, until WBC count at least 10 x 10<sup>9</sup>/L above nadir
 '''21-day cycle for 4 cycles'''
+</div></div>
 ===References===
 # Loehrer PJ Sr, Jiroutek M, Aisner S, Aisner J, Green M, Thomas CR Jr, Livingston R, Johnson DH. Combined etoposide, ifosfamide, and cisplatin in the treatment of patients with advanced thymoma and thymic carcinoma: an intergroup trial. Cancer. 2001 Jun 1;91(11):2010-5. [https://doi.org/10.1002/1097-0142%2820010601%2991:11%3C2010::AID-CNCR1226%3E3.0.CO;2-2 link to original article] '''contains dosing details in manuscript''' [https://pubmed.ncbi.nlm.nih.gov/11391579 PubMed]
 =Advanced or metastatic disease, subsequent lines of therapy=
 ==Capecitabine & Gemcitabine {{#subobject:cabb5e|Regimen=1}}==
 CAP-GEM: '''<u>CAP</u>'''ecitabine & '''<u>GEM</u>'''citabine
+<div class="toccolours" style="background-color:#eeeeee">
 ===Regimen {{#subobject:335173|Variant=1}}===
 {| class="wikitable" style="width: 60%; text-align:center;"
@@ Line 249: / Line 240: @@
 |-
 |}
+<div class="toccolours" style="background-color:#b3e2cd">
 ====Chemotherapy====
 *[[Capecitabine (Xeloda)]] 650 mg/m<sup>2</sup> PO twice per day on days 1 to 14
 *[[Gemcitabine (Gemzar)]] 1000 mg/m<sup>2</sup> IV once per day on days 1 & 8
 '''21-day cycles'''
+</div></div>
 ===References===
 # Palmieri G, Merola G, Federico P, Petillo L, Marino M, Lalle M, Milella M, Ceribelli A, Montella L, Merola C, Del Prete S, Bergaglio M, De Placido S, Di Lorenzo G. Preliminary results of phase II study of capecitabine and gemcitabine (CAP-GEM) in patients with metastatic pretreated thymic epithelial tumors (TETs). Ann Oncol. 2010 Jun;21(6):1168-72. Epub 2009 Oct 30. [https://doi.org/10.1093/annonc/mdp483 link to original article] [https://pubmed.ncbi.nlm.nih.gov/19880439 PubMed]
 ## '''Update:''' Palmieri G, Buonerba C, Ottaviano M, Federico P, Calabrese F, Von Arx C, De Maio AP, Marino M, Lalle M, Montella L, Merola C, Milella M, Bergaglio M, Di Lorenzo G, Damiano V. Capecitabine plus gemcitabine in thymic epithelial tumors: final analysis of a Phase II trial. Future Oncol. 2014 Nov;10(14):2141-7. [http://www.futuremedicine.com/doi/full/10.2217/fon.14.144 link to original article] '''contains dosing details in abstract''' [https://pubmed.ncbi.nlm.nih.gov/25471029 PubMed]
 ==Everolimus monotherapy {{#subobject:e7a59f|Regimen=1}}==
+<div class="toccolours" style="background-color:#eeeeee">
 ===Regimen {{#subobject:82c282|Variant=1}}===
 {| class="wikitable" style="width: 60%; text-align:center;"
@@ Line 272: / Line 262: @@
 |-
 |}
+<div class="toccolours" style="background-color:#b3e2cd">
 ====Targeted therapy====
 *[[Everolimus (Afinitor)]] 10 mg PO once per day
 '''Continued indefinitely'''
+</div></div>
 ===References===
 <!--
 # '''Abstract:''' Paolo A. Zucali, Tommaso Martino De Pas, Giovannella Palmieri, Adolfo G. Favaretto, Antonio Chella, Marcello Tiseo, Michele Caruso, Matteo Perrino... Fabio De Vincenzo, Matteo Simonelli, Francesca Toffalorio, Piera Federico, Giulia Pasello, Marco Ali, Laura Giordano, Monica Bertossi, Armando Santoro. Phase II study of everolimus in patients with thymoma and thymic carcinoma previously treated with cisplatin-based chemotherapy. Journal of Clinical Oncology 32, no. 15_suppl (May 2014) 7527-7527. [https://doi.org/10.1200/jco.2014.32.15_suppl.7527 link to abstract] -->
 # '''ONC-2010-001:''' Zucali PA, De Pas T, Palmieri G, Favaretto A, Chella A, Tiseo M, Caruso M, Simonelli M, Perrino M, De Vincenzo F, Toffalorio F, Damiano V, Pasello G, Garbella E, Ali M, Conforti F, Ottaviano M, Cioffi A, De Placido S, Giordano L, Bertossi M, Destro A, Di Tommaso L, Santoro A. Phase II study of everolimus in patients with thymoma and thymic carcinoma previously treated with cisplatin-based chemotherapy. J Clin Oncol. 2018 Feb 1;36(4):342-349. Epub 2017 Dec 14.[https://doi.org/10.1200/JCO.2017.74.4078 link to original article] '''contains dosing details in manuscript''' [https://pubmed.ncbi.nlm.nih.gov/29240542 PubMed]
 ==Ifosfamide monotherapy {{#subobject:69edc9|Regimen=1}}==
+<div class="toccolours" style="background-color:#eeeeee">
 ===Regimen variant #1, intermittent dosing {{#subobject:d0877e|Variant=1}}===
 {| class="wikitable" style="width: 40%; text-align:center;"
@@ Line 293: / Line 282: @@
 |-
 |}
+<div class="toccolours" style="background-color:#b3e2cd">
 ====Chemotherapy====
 *[[Ifosfamide (Ifex)]] 1500 mg/m<sup>2</sup> IV over 30 minutes once per day on days 1 to 5
 ====Supportive therapy====
 *[[Mesna (Mesnex)]] 400 mg IV bolus once per day on days 1 to 5, '''given before ifosfamide''', then 1000 mg/m<sup>2</sup> IV over 7.5 hours (total dose per cycle: 7000 mg/m<sup>2</sup>)
 '''21-day cycles'''
+</div></div><br>
+<div class="toccolours" style="background-color:#eeeeee">
 ===Regimen variant #2, continuous dosing {{#subobject:1d5654|Variant=1}}===
 {| class="wikitable" style="width: 40%; text-align:center;"
@@ Line 310: / Line 299: @@
 |-
 |}
+<div class="toccolours" style="background-color:#b3e2cd">
 ====Chemotherapy====
 *[[Ifosfamide (Ifex)]] 1500 mg/m<sup>2</sup>/day IV continuous infusion over 120 hours, started on day 1, '''given second''' (total dose per cycle: 6000 mg/m<sup>2</sup>)
 ====Supportive therapy====
 *[[Mesna (Mesnex)]] 2000 mg IV bolus once on day 1, '''given first''', then 1500 mg/m<sup>2</sup>/day IV continuous infusion over 7 days (total dose per cycle: 12,500 mg/m<sup>2</sup>)
 '''21-day cycles'''
+</div></div>
 ===References===
 # Highley MS, Underhill CR, Parnis FX, Karapetis C, Rankin E, Dussek J, Bryant B, Rowland C, Hodson N, Hughes J, Harper PG. Treatment of invasive thymoma with single-agent ifosfamide. J Clin Oncol. 1999 Sep;17(9):2737-44. [https://doi.org/10.1200/jco.1999.17.9.2737 link to original article] '''contains dosing details in manuscript''' [https://pubmed.ncbi.nlm.nih.gov/10561348 PubMed] content property of [http://hemonc.org HemOnc.org]
 ==Octreotide monotherapy {{#subobject:109390|Regimen=1}}==
+<div class="toccolours" style="background-color:#eeeeee">
 ===Regimen variant #1, brief course {{#subobject:d7858d|Variant=1}}===
 {| class="wikitable" style="width: 40%; text-align:center;"
@@ Line 330: / Line 317: @@
 |[https://doi.org/10.1200/jco.2004.02.047 Loehrer et al. 2004]
 |style="background-color:#91cf61"|Phase 2
 |-
 |}
+<div class="toccolours" style="background-color:#b3e2cd">
 ====Endocrine therapy====
 *[[Octreotide (Sandostatin)]] 0.5 mg SC three times per day
 '''1-month cycle for 2 cycles'''
+</div>
+<div class="toccolours" style="background-color:#cbd5e7">
 ====Subsequent treatment====
 *If stable disease, patients would transition to [[#Octreotide_.26_Prednisone|octreotide & prednisone]]
+</div></div><br>
+<div class="toccolours" style="background-color:#eeeeee">
 ===Regimen variant #2, extended course {{#subobject:2fffe4|Variant=1}}===
 {| class="wikitable" style="width: 40%; text-align:center;"
@@ Line 349: / Line 338: @@
 |-
 |}
+<div class="toccolours" style="background-color:#b3e2cd">
 ====Endocrine therapy====
 *[[Octreotide (Sandostatin)]] 0.5 mg SC three times per day
 '''1-month cycle for up to 12 cycles'''
+</div></div>
 ===References===
 # Loehrer PJ Sr, Wang W, Johnson DH, Aisner SC, Ettinger DS; Eastern Cooperative Oncology Group. Octreotide alone or with prednisone in patients with advanced thymoma and thymic carcinoma: an Eastern Cooperative Oncology Group Phase II Trial. J Clin Oncol. 2004 Jan 15;22(2):293-9. [https://doi.org/10.1200/jco.2004.02.047 link to original article] '''contains dosing details in manuscript''' [https://pubmed.ncbi.nlm.nih.gov/14722038 PubMed]
 ==Octreotide & Prednisone {{#subobject:5a36da|Regimen=1}}==
+<div class="toccolours" style="background-color:#eeeeee">
 ===Regimen {{#subobject:860b16|Variant=1}}===
 {| class="wikitable" style="width: 40%; text-align:center;"
@@ Line 368: / Line 356: @@
 |-
 |}
+<div class="toccolours" style="background-color:#cbd5e8">
 ====Preceding treatment====
 *[[#Octreotide_monotherapy|Octreotide]] x 2 mo
+</div>
+<div class="toccolours" style="background-color:#b3e2cd">
 ====Endocrine therapy====
 *[[Octreotide (Sandostatin)]] 0.5 mg SC three times per day
 *[[Prednisone (Sterapred)]] 0.6 mg/kg PO once per day
 '''1-month cycle for up to 10 cycles'''
+</div></div>
 ===References===
 # Loehrer PJ Sr, Wang W, Johnson DH, Aisner SC, Ettinger DS; Eastern Cooperative Oncology Group. Octreotide alone or with prednisone in patients with advanced thymoma and thymic carcinoma: an Eastern Cooperative Oncology Group Phase II Trial. J Clin Oncol. 2004 Jan 15;22(2):293-9. [https://doi.org/10.1200/jco.2004.02.047 link to original article] '''contains dosing details in manuscript''' [https://pubmed.ncbi.nlm.nih.gov/14722038 PubMed]
 ==Sunitinib monotherapy {{#subobject:b3730c|Regimen=1}}==
+<div class="toccolours" style="background-color:#eeeeee">
 ===Regimen {{#subobject:1d254c|Variant=1}}===
 {| class="wikitable" style="width: 40%; text-align:center;"
@@ Line 390: / Line 379: @@
 |-
 |}
+<div class="toccolours" style="background-color:#b3e2cd">
 ====Targeted therapy====
 *[[Sunitinib (Sutent)]] 50 mg PO once per day on days 1 to 28
 '''42-day cycles'''
+</div></div>
 ===References===
 # '''NCI 12-C-0118:''' Thomas A, Rajan A, Berman A, Tomita Y, Brzezniak C, Lee MJ, Lee S, Ling A, Spittler AJ, Carter CA, Guha U, Wang Y, Szabo E, Meltzer P, Steinberg SM, Trepel JB, Loehrer PJ, Giaccone G. Sunitinib in patients with chemotherapy-refractory thymoma and thymic carcinoma: an open-label phase 2 trial. Lancet Oncol. 2015 Feb;16(2):177-86. Epub 2015 Jan 13. Erratum in: Lancet Oncol. 2015 Mar;16(3):e105. [https://doi.org/10.1016/s1470-2045(14)71181-7 link to original article] '''contains dosing details in manuscript''' [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4401497/ link to PMC article] [https://pubmed.ncbi.nlm.nih.gov/25592632 PubMed] NCT01621568
 =Investigational agents=
 ''Drugs with preliminary evidence of efficacy in this disease subtype.''
 *[[Cixutumumab (IMC-A12)]]
 [[Category:Thymoma regimens]]
 [[Category:Disease-specific pages]]
 [[Category:Thoracic cancers]]

Difference between revisions of "Thymoma"

Revision as of 23:47, 28 February 2023

Guidelines

ESMO

NCCN

Neoadjuvant therapy for borderline resectable disease

PAC

Regimen

Chemotherapy

Glucocorticoid therapy

Supportive therapy

Subsequent treatment

References

Adjuvant therapy

PAC

Regimen

Preceding treatment

Chemotherapy

Glucocorticoid therapy

References

Radiation therapy

Regimen

Preceding treatment

Radiotherapy

Subsequent treatment

References

Advanced or metastatic disease, first-line therapy

ADOC

Regimen

Chemotherapy

References

Carboplatin & Paclitaxel (CP)

Regimen

Chemotherapy

Supportive therapy

References

Cisplatin & Etoposide (EP)

Regimen

Chemotherapy

Supportive therapy

References

PAC

Regimen

Chemotherapy

Supportive therapy

References

VIP

Regimen

Chemotherapy

Supportive therapy

References

Advanced or metastatic disease, subsequent lines of therapy

Capecitabine & Gemcitabine

Regimen

Chemotherapy

References

Everolimus monotherapy

Regimen

Targeted therapy

References

Ifosfamide monotherapy

Regimen variant #1, intermittent dosing

Chemotherapy

Supportive therapy

Regimen variant #2, continuous dosing

Chemotherapy

Supportive therapy

References

Octreotide monotherapy

Regimen variant #1, brief course

Endocrine therapy

Subsequent treatment

Regimen variant #2, extended course

Endocrine therapy

References

Octreotide & Prednisone

Regimen

Preceding treatment

Endocrine therapy

References