Difference between revisions of "Thymoma"
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[[#top|Back to Top]] | [[#top|Back to Top]] | ||
</div> | </div> | ||
− | {{#lst: | + | {{#lst:Editorial board transclusions|thoracic}} |
{| class="wikitable" style="float:right; margin-right: 5px;" | {| class="wikitable" style="float:right; margin-right: 5px;" | ||
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{{TOC limit|limit=3}} | {{TOC limit|limit=3}} | ||
=Guidelines= | =Guidelines= | ||
− | ==[ | + | '''Given the rapid change in evidence in many areas of hematology/oncology, readers are encouraged to consider any guideline published 5+ years ago to be for historical purposes, only.''' |
− | *'''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.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://pubmed.ncbi.nlm.nih.gov/26314779 PubMed] | |
− | *[https://www.nccn.org/ | + | |
+ | ==NCCN== | ||
+ | *[https://www.nccn.org/guidelines/guidelines-detail?category=1&id=1469 NCCN Guidelines - Thymomas and Thymic Carcinomas] | ||
+ | |||
=Neoadjuvant therapy for borderline resectable disease= | =Neoadjuvant therapy for borderline resectable disease= | ||
− | ==PAC {{#subobject:96fd1b|Regimen=1}}== | + | ==PAC-P {{#subobject:96fd1b|Regimen=1}}== |
PAC: '''<u>P</u>'''latinol (Cisplatin), '''<u>A</u>'''driamycin (Doxorubicin), '''<u>C</u>'''yclophosphamide<br> | 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) | CAP: '''<u>C</u>'''yclophosphamide, '''<u>A</u>'''driamycin (Doxorubicin), '''<u>P</u>'''latinol (Cisplatin) | ||
<div class="toccolours" style="background-color:#eeeeee"> | <div class="toccolours" style="background-color:#eeeeee"> | ||
===Regimen {{#subobject:dcf948|Variant=1}}=== | ===Regimen {{#subobject:dcf948|Variant=1}}=== | ||
− | {| class="wikitable" style="width: | + | {| class="wikitable sortable" style="width: 60%; text-align:center;" |
− | !style="width: | + | !style="width: 33%"|Study |
− | !style="width: | + | !style="width: 33%"|Dates of enrollment |
+ | !style="width: 33%"|[[Levels_of_Evidence#Evidence|Evidence]] | ||
|- | |- | ||
|[https://doi.org/10.1016/j.lungcan.2003.12.010 Kim et al. 2004] | |[https://doi.org/10.1016/j.lungcan.2003.12.010 Kim et al. 2004] | ||
+ | |1990-02 to 2000-04 | ||
|style="background-color:#91cf61"|Phase 2 | |style="background-color:#91cf61"|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.'' | + | ''Note: while this regimen is conventionally referred to as PAC or CAP, it also includes a high-dose prednisone component with likely antineoplastic properties, and has been renamed PAC-P here.'' |
<div class="toccolours" style="background-color:#b3e2cd"> | <div class="toccolours" style="background-color:#b3e2cd"> | ||
====Chemotherapy==== | ====Chemotherapy==== | ||
Line 44: | Line 49: | ||
<div class="toccolours" style="background-color:#cbd5e7"> | <div class="toccolours" style="background-color:#cbd5e7"> | ||
====Subsequent treatment==== | ====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 [[# | + | *[[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 adjuvant [[#Radiation_therapy|RT]], then [[#PAC-P_2|PAC]] consolidation |
</div></div> | </div></div> | ||
===References=== | ===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] ''' | + | # 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] '''dosing details in manuscript have been reviewed by our editors''' [https://pubmed.ncbi.nlm.nih.gov/15140551/ PubMed] |
=Adjuvant therapy= | =Adjuvant therapy= | ||
− | ==PAC {{#subobject:76239f|Regimen=1}}== | + | ==PAC-P {{#subobject:76239f|Regimen=1}}== |
PAC: '''<u>P</u>'''latinol (Cisplatin), '''<u>A</u>'''driamycin (Doxorubicin), '''<u>C</u>'''yclophosphamide<br> | 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) | CAP: '''<u>C</u>'''yclophosphamide, '''<u>A</u>'''driamycin (Doxorubicin), '''<u>P</u>'''latinol (Cisplatin) | ||
<div class="toccolours" style="background-color:#eeeeee"> | <div class="toccolours" style="background-color:#eeeeee"> | ||
===Regimen {{#subobject:adbf18|Variant=1}}=== | ===Regimen {{#subobject:adbf18|Variant=1}}=== | ||
− | {| class="wikitable" style="width: | + | {| class="wikitable sortable" style="width: 60%; text-align:center;" |
− | !style="width: | + | !style="width: 33%"|Study |
− | !style="width: | + | !style="width: 33%"|Dates of enrollment |
+ | !style="width: 33%"|[[Levels_of_Evidence#Evidence|Evidence]] | ||
|- | |- | ||
|[https://doi.org/10.1016/j.lungcan.2003.12.010 Kim et al. 2004] | |[https://doi.org/10.1016/j.lungcan.2003.12.010 Kim et al. 2004] | ||
+ | |1990-02 to 2000-04 | ||
|style="background-color:#91cf61"|Phase 2 | |style="background-color:#91cf61"|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.'' | + | ''Note: while this regimen is conventionally referred to as PAC or CAP, it also includes a high-dose prednisone component with likely antineoplastic properties, and has been renamed PAC-P, here. Also note that these doses are 80% of the induction doses, except for the prednisone.'' |
<div class="toccolours" style="background-color:#cbd5e8"> | <div class="toccolours" style="background-color:#cbd5e8"> | ||
====Preceding treatment==== | ====Preceding treatment==== | ||
− | *[[#Radiation_therapy|RT]] | + | *Definitive [[#Radiation_therapy|RT]] |
</div> | </div> | ||
<div class="toccolours" style="background-color:#b3e2cd"> | <div class="toccolours" style="background-color:#b3e2cd"> | ||
Line 77: | Line 84: | ||
</div></div> | </div></div> | ||
===References=== | ===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] ''' | + | # 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] '''dosing details in manuscript have been reviewed by our editors''' [https://pubmed.ncbi.nlm.nih.gov/15140551/ PubMed] |
==Radiation therapy {{#subobject:afc56b|Regimen=1}}== | ==Radiation therapy {{#subobject:afc56b|Regimen=1}}== | ||
<div class="toccolours" style="background-color:#eeeeee"> | <div class="toccolours" style="background-color:#eeeeee"> | ||
===Regimen {{#subobject:07cb87|Variant=1}}=== | ===Regimen {{#subobject:07cb87|Variant=1}}=== | ||
− | {| class="wikitable" style="width: | + | {| class="wikitable sortable" style="width: 60%; text-align:center;" |
− | !style="width: | + | !style="width: 33%"|Study |
− | !style="width: | + | !style="width: 33%"|Dates of enrollment |
+ | !style="width: 33%"|[[Levels_of_Evidence#Evidence|Evidence]] | ||
|- | |- | ||
|[https://doi.org/10.1016/j.lungcan.2003.12.010 Kim et al. 2004] | |[https://doi.org/10.1016/j.lungcan.2003.12.010 Kim et al. 2004] | ||
+ | |1990-02 to 2000-04 | ||
|style="background-color:#91cf61"|Phase 2 | |style="background-color:#91cf61"|Phase 2 | ||
|- | |- | ||
Line 91: | Line 100: | ||
<div class="toccolours" style="background-color:#cbd5e8"> | <div class="toccolours" style="background-color:#cbd5e8"> | ||
====Preceding treatment==== | ====Preceding treatment==== | ||
− | *[[#PAC|PAC]] induction, then [[Surgery#Thymectomy|surgery]] (in some cases) | + | *[[#PAC-P|PAC-P]] induction, then [[Surgery#Thymectomy|surgery]] (in some cases) |
</div> | </div> | ||
<div class="toccolours" style="background-color:#b3e2cd"> | <div class="toccolours" style="background-color:#b3e2cd"> | ||
====Radiotherapy==== | ====Radiotherapy==== | ||
− | *If tumor is completely resected and has at least 80% necrosis: | + | *[[External beam radiotherapy]] by the following response-based criteria: |
− | *If tumor is incompletely resected or has less than 80% necrosis: | + | *If tumor is completely resected and has at least 80% necrosis: 5000 cGy is administered 3 to 6 weeks after surgery |
+ | *If tumor is incompletely resected or has less than 80% necrosis: 6000 cGy is administered | ||
'''One course''' | '''One course''' | ||
</div> | </div> | ||
<div class="toccolours" style="background-color:#cbd5e7"> | <div class="toccolours" style="background-color:#cbd5e7"> | ||
====Subsequent treatment==== | ====Subsequent treatment==== | ||
− | *[[# | + | *Adjuvant [[#PAC-P_2|PAC-P]] x 3 |
</div></div> | </div></div> | ||
===References=== | ===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] ''' | + | # 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] '''dosing details in manuscript have been reviewed by our editors''' [https://pubmed.ncbi.nlm.nih.gov/15140551/ PubMed] |
=Advanced or metastatic disease, first-line therapy= | =Advanced or metastatic disease, first-line therapy= | ||
==ADOC {{#subobject:a329b4|Regimen=1}}== | ==ADOC {{#subobject:a329b4|Regimen=1}}== | ||
Line 110: | Line 120: | ||
<div class="toccolours" style="background-color:#eeeeee"> | <div class="toccolours" style="background-color:#eeeeee"> | ||
===Regimen {{#subobject:ee5c1b|Variant=1}}=== | ===Regimen {{#subobject:ee5c1b|Variant=1}}=== | ||
− | {| class="wikitable" style="width: | + | {| class="wikitable sortable" style="width: 60%; text-align:center;" |
− | !style="width: | + | !style="width: 33%"|Study |
− | !style="width: | + | !style="width: 33%"|Dates of enrollment |
+ | !style="width: 33%"|[[Levels_of_Evidence#Evidence|Evidence]] | ||
|- | |- | ||
|[https://doi.org/10.1002/1097-0142%2819910701)68:1%3C30::AID-CNCR2820680106%3E3.0.CO;2-4 Fornasiero et al. 1991] | |[https://doi.org/10.1002/1097-0142%2819910701)68:1%3C30::AID-CNCR2820680106%3E3.0.CO;2-4 Fornasiero et al. 1991] | ||
+ | |1977-1990 | ||
|style="background-color:#ffffbe"|Retrospective | |style="background-color:#ffffbe"|Retrospective | ||
|- | |- | ||
Line 128: | Line 140: | ||
</div></div> | </div></div> | ||
===References=== | ===References=== | ||
− | # '''Retrospective:''' Fornasiero A, Daniele O, Ghiotto C, Piazza M, Fiore-Donati L, Calabró F, Rea F, Fiorentino MV. Chemotherapy for invasive thymoma | + | # '''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] '''dosing details in manuscript have been reviewed by our editors''' [https://pubmed.ncbi.nlm.nih.gov/2049749/ PubMed] |
+ | |||
==Carboplatin & Paclitaxel (CP) {{#subobject:410ff6|Regimen=1}}== | ==Carboplatin & Paclitaxel (CP) {{#subobject:410ff6|Regimen=1}}== | ||
<div class="toccolours" style="background-color:#eeeeee"> | <div class="toccolours" style="background-color:#eeeeee"> | ||
===Regimen {{#subobject:34b20a|Variant=1}}=== | ===Regimen {{#subobject:34b20a|Variant=1}}=== | ||
− | {| class="wikitable" style="width: | + | {| class="wikitable sortable" style="width: 60%; text-align:center;" |
− | !style="width: | + | !style="width: 33%"|Study |
− | !style="width: | + | !style="width: 33%"|Dates of enrollment |
+ | !style="width: 33%"|[[Levels_of_Evidence#Evidence|Evidence]] | ||
|- | |- | ||
|[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3107762/ Lemma et al. 2011] | |[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3107762/ Lemma et al. 2011] | ||
+ | |2001-02 to 2008-01 | ||
|style="background-color:#91cf61"|Phase 2 | |style="background-color:#91cf61"|Phase 2 | ||
|- | |- | ||
Line 145: | Line 160: | ||
*[[Paclitaxel (Taxol)]] 225 mg/m<sup>2</sup> IV over 3 hours once on day 1, '''given first''' | *[[Paclitaxel (Taxol)]] 225 mg/m<sup>2</sup> IV over 3 hours once on day 1, '''given first''' | ||
====Supportive therapy==== | ====Supportive therapy==== | ||
− | *[[Cimetidine (Tagamet)]] 300 mg IV once on day 1; 60 minutes prior to | + | *[[Cimetidine (Tagamet)]] 300 mg IV once on day 1; 60 minutes prior to paclitaxel |
− | *[[Diphenhydramine (Benadryl)]] 25 mg IV once on day 1; 60 minutes prior to | + | *[[Diphenhydramine (Benadryl)]] 25 mg IV once on day 1; 60 minutes prior to paclitaxel |
− | *[[Dexamethasone (Decadron)]] 20 mg IV once on day 1; 60 minutes prior to | + | *[[Dexamethasone (Decadron)]] 20 mg IV once on day 1; 60 minutes prior to paclitaxel |
'''21-day cycle for up to 6 cycles''' | '''21-day cycle for up to 6 cycles''' | ||
</div></div> | </div></div> | ||
===References=== | ===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] ''' | + | # 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] '''dosing details in manuscript have been reviewed by our editors''' [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3107762/ link to PMC article] [https://pubmed.ncbi.nlm.nih.gov/21502559/ PubMed] |
− | == | + | ==CISCA {{#subobject:ce7f87|Regimen=1}}== |
− | + | CISCA: '''<u>CIS</u>'''platin, '''<u>C</u>'''yclophosphamide, '''<u>A</u>'''driamycin (Doxorubicin) | |
+ | <br>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"> | <div class="toccolours" style="background-color:#eeeeee"> | ||
− | ===Regimen {{#subobject: | + | ===Regimen {{#subobject:f15804|Variant=1}}=== |
− | {| class="wikitable" style="width: | + | {| class="wikitable sortable" style="width: 60%; text-align:center;" |
− | !style="width: | + | !style="width: 33%"|Study |
− | !style="width: | + | !style="width: 33%"|Dates of enrollment |
+ | !style="width: 33%"|[[Levels_of_Evidence#Evidence|Evidence]] | ||
|- | |- | ||
− | |[https://doi.org/10. | + | |[https://doi.org/10.7326/0003-4819-113-7-520 Loehrer et al. 1990] |
+ | |1983-04 to 1988-03 | ||
|style="background-color:#91cf61"|Phase 2 | |style="background-color:#91cf61"|Phase 2 | ||
|- | |- | ||
Line 166: | Line 185: | ||
<div class="toccolours" style="background-color:#b3e2cd"> | <div class="toccolours" style="background-color:#b3e2cd"> | ||
====Chemotherapy==== | ====Chemotherapy==== | ||
− | *[[Cisplatin (Platinol)]] | + | *[[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==== | ====Supportive therapy==== | ||
− | * | + | *1 liter [[Normal saline|NS]] over 2 hours at least 2 hours before and after cisplatin therapy |
+ | *Corticosteroids use for antiemesis was specifically discouraged unless the indication was for myasthenia gravis | ||
'''21-day cycle for up to 8 cycles''' | '''21-day cycle for up to 8 cycles''' | ||
</div></div> | </div></div> | ||
+ | |||
===References=== | ===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] '''dosing details in manuscript have been reviewed by our editors''' [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] '''dosing details in manuscript have been reviewed by our editors''' [https://pubmed.ncbi.nlm.nih.gov/8201378/ 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"> | <div class="toccolours" style="background-color:#eeeeee"> | ||
− | ===Regimen {{#subobject: | + | ===Regimen {{#subobject:906dfc|Variant=1}}=== |
− | {| class="wikitable" style="width: | + | {| class="wikitable sortable" style="width: 60%; text-align:center;" |
− | !style="width: | + | !style="width: 33%"|Study |
− | !style="width: | + | !style="width: 33%"|Dates of enrollment |
+ | !style="width: 33%"|[[Levels_of_Evidence#Evidence|Evidence]] | ||
|- | |- | ||
− | |[https://doi.org/10. | + | |[https://doi.org/10.1200/jco.1996.14.3.814 Giaccone et al. 1996] |
+ | |1985-09 to 1991-08 | ||
|style="background-color:#91cf61"|Phase 2 | |style="background-color:#91cf61"|Phase 2 | ||
|- | |- | ||
Line 189: | Line 213: | ||
<div class="toccolours" style="background-color:#b3e2cd"> | <div class="toccolours" style="background-color:#b3e2cd"> | ||
====Chemotherapy==== | ====Chemotherapy==== | ||
− | *[[Cisplatin (Platinol)]] | + | *[[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==== | ====Supportive therapy==== | ||
− | * | + | *"A program of forced hydration" |
− | |||
'''21-day cycle for up to 8 cycles''' | '''21-day cycle for up to 8 cycles''' | ||
</div></div> | </div></div> | ||
===References=== | ===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] '''dosing details in manuscript have been reviewed by our editors''' [https://pubmed.ncbi.nlm.nih.gov/8622029/ PubMed] |
− | |||
==VIP {{#subobject:e1d675|Regimen=1}}== | ==VIP {{#subobject:e1d675|Regimen=1}}== | ||
VIP: '''<u>V</u>'''epesid (Etoposide), '''<u>I</u>'''fosfamide, '''<u>P</u>'''latinol (Cisplatin) | VIP: '''<u>V</u>'''epesid (Etoposide), '''<u>I</u>'''fosfamide, '''<u>P</u>'''latinol (Cisplatin) | ||
<div class="toccolours" style="background-color:#eeeeee"> | <div class="toccolours" style="background-color:#eeeeee"> | ||
===Regimen {{#subobject:2235f2|Variant=1}}=== | ===Regimen {{#subobject:2235f2|Variant=1}}=== | ||
− | {| class="wikitable" style="width: | + | {| class="wikitable sortable" style="width: 60%; text-align:center;" |
− | !style="width: | + | !style="width: 33%"|Study |
− | !style="width: | + | !style="width: 33%"|Dates of enrollment |
+ | !style="width: 33%"|[[Levels_of_Evidence#Evidence|Evidence]] | ||
|- | |- | ||
|[https://doi.org/10.1002/1097-0142%2820010601%2991:11%3C2010::AID-CNCR1226%3E3.0.CO;2-2 Loehrer et al. 2001] | |[https://doi.org/10.1002/1097-0142%2820010601%2991:11%3C2010::AID-CNCR1226%3E3.0.CO;2-2 Loehrer et al. 2001] | ||
+ | |1995-07 to 1997-02 | ||
|style="background-color:#91cf61"|Phase 2 | |style="background-color:#91cf61"|Phase 2 | ||
|- | |- | ||
Line 218: | Line 241: | ||
*[[Cisplatin (Platinol)]] 20 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==== | ====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 | + | *[[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 (total dose per cycle: 1920 mg/m<sup>2</sup>) |
− | *1 liter normal saline once per day on days 1 to 4, prior to | + | *1 liter normal saline once per day on days 1 to 4, prior to cisplatin |
*[[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 | *[[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''' | '''21-day cycle for 4 cycles''' | ||
</div></div> | </div></div> | ||
===References=== | ===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] ''' | + | # 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] '''dosing details in manuscript have been reviewed by our editors''' [https://pubmed.ncbi.nlm.nih.gov/11391579/ PubMed] |
=Advanced or metastatic disease, subsequent lines of therapy= | =Advanced or metastatic disease, subsequent lines of therapy= | ||
==Capecitabine & Gemcitabine {{#subobject:cabb5e|Regimen=1}}== | ==Capecitabine & Gemcitabine {{#subobject:cabb5e|Regimen=1}}== | ||
Line 230: | Line 253: | ||
<div class="toccolours" style="background-color:#eeeeee"> | <div class="toccolours" style="background-color:#eeeeee"> | ||
===Regimen {{#subobject:335173|Variant=1}}=== | ===Regimen {{#subobject:335173|Variant=1}}=== | ||
− | {| class="wikitable" style="width: | + | {| class="wikitable sortable" style="width: 80%; text-align:center;" |
− | !style="width: | + | !style="width: 25%"|Study |
− | !style="width: | + | !style="width: 25%"|Dates of enrollment |
− | !style="width: | + | !style="width: 25%"|[[Levels_of_Evidence#Evidence|Evidence]] |
+ | !style="width: 25%"|[[Levels_of_Evidence#Efficacy|Efficacy]] | ||
|- | |- | ||
|[https://doi.org/10.1093/annonc/mdp483 Palmieri et al. 2009] | |[https://doi.org/10.1093/annonc/mdp483 Palmieri et al. 2009] | ||
+ | |2005-11 to 2008-08 | ||
|style="background-color:#91cf61"|Phase 2 | |style="background-color:#91cf61"|Phase 2 | ||
|ORR: 40% | |ORR: 40% | ||
Line 247: | Line 272: | ||
</div></div> | </div></div> | ||
===References=== | ===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] | + | # 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. [ | + | ## '''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. [https://doi.org/10.2217/fon.14.144 link to original article] '''dosing details in abstract have been reviewed by our editors''' [https://pubmed.ncbi.nlm.nih.gov/25471029/ PubMed] |
==Everolimus monotherapy {{#subobject:e7a59f|Regimen=1}}== | ==Everolimus monotherapy {{#subobject:e7a59f|Regimen=1}}== | ||
<div class="toccolours" style="background-color:#eeeeee"> | <div class="toccolours" style="background-color:#eeeeee"> | ||
===Regimen {{#subobject:82c282|Variant=1}}=== | ===Regimen {{#subobject:82c282|Variant=1}}=== | ||
− | {| class="wikitable" style="width: | + | {| class="wikitable sortable" style="width: 80%; text-align:center;" |
− | !style="width: | + | !style="width: 25%"|Study |
− | !style="width: | + | !style="width: 25%"|Dates of enrollment |
− | !style="width: | + | !style="width: 25%"|[[Levels_of_Evidence#Evidence|Evidence]] |
+ | !style="width: 25%"|[[Levels_of_Evidence#Efficacy|Efficacy]] | ||
|- | |- | ||
|[https://doi.org/10.1200/JCO.2017.74.4078 Zucali et al. 2017 (ONC-2010-001)] | |[https://doi.org/10.1200/JCO.2017.74.4078 Zucali et al. 2017 (ONC-2010-001)] | ||
+ | |2011-02-17 to 2013-10-21 | ||
|style="background-color:#91cf61"|Phase 2 | |style="background-color:#91cf61"|Phase 2 | ||
|DCR: 88% | |DCR: 88% | ||
Line 270: | Line 297: | ||
<!-- | <!-- | ||
# '''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] --> | # '''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] ''' | + | # '''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] '''dosing details in manuscript have been reviewed by our editors''' [https://pubmed.ncbi.nlm.nih.gov/29240542/ PubMed] |
==Ifosfamide monotherapy {{#subobject:69edc9|Regimen=1}}== | ==Ifosfamide monotherapy {{#subobject:69edc9|Regimen=1}}== | ||
<div class="toccolours" style="background-color:#eeeeee"> | <div class="toccolours" style="background-color:#eeeeee"> | ||
===Regimen variant #1, intermittent dosing {{#subobject:d0877e|Variant=1}}=== | ===Regimen variant #1, intermittent dosing {{#subobject:d0877e|Variant=1}}=== | ||
− | {| class="wikitable" style="width: | + | {| class="wikitable sortable" style="width: 60%; text-align:center;" |
− | !style="width: | + | !style="width: 33%"|Study |
− | !style="width: | + | !style="width: 33%"|Dates of enrollment |
+ | !style="width: 33%"|[[Levels_of_Evidence#Evidence|Evidence]] | ||
|- | |- | ||
|[https://doi.org/10.1200/jco.1999.17.9.2737 Highley et al. 1999] | |[https://doi.org/10.1200/jco.1999.17.9.2737 Highley et al. 1999] | ||
− | |style="background-color:#ffffbe"|Pilot, | + | |1984-07 to 1996-07 |
+ | |style="background-color:#ffffbe"|Pilot, fewer than 20 pts | ||
|- | |- | ||
|} | |} | ||
Line 291: | Line 320: | ||
<div class="toccolours" style="background-color:#eeeeee"> | <div class="toccolours" style="background-color:#eeeeee"> | ||
===Regimen variant #2, continuous dosing {{#subobject:1d5654|Variant=1}}=== | ===Regimen variant #2, continuous dosing {{#subobject:1d5654|Variant=1}}=== | ||
− | {| class="wikitable" style="width: | + | {| class="wikitable sortable" style="width: 60%; text-align:center;" |
− | !style="width: | + | !style="width: 33%"|Study |
− | !style="width: | + | !style="width: 33%"|Dates of enrollment |
+ | !style="width: 33%"|[[Levels_of_Evidence#Evidence|Evidence]] | ||
|- | |- | ||
|[https://doi.org/10.1200/jco.1999.17.9.2737 Highley et al. 1999] | |[https://doi.org/10.1200/jco.1999.17.9.2737 Highley et al. 1999] | ||
− | |style="background-color:#ffffbe"|Pilot, | + | |1984-07 to 1996-07 |
+ | |style="background-color:#ffffbe"|Pilot, fewer than 20 pts | ||
|- | |- | ||
|} | |} | ||
Line 307: | Line 338: | ||
</div></div> | </div></div> | ||
===References=== | ===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] ''' | + | # 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] '''dosing details in manuscript have been reviewed by our editors''' [https://pubmed.ncbi.nlm.nih.gov/10561348/ PubMed] content property of [https://hemonc.org HemOnc.org] |
==Octreotide monotherapy {{#subobject:109390|Regimen=1}}== | ==Octreotide monotherapy {{#subobject:109390|Regimen=1}}== | ||
<div class="toccolours" style="background-color:#eeeeee"> | <div class="toccolours" style="background-color:#eeeeee"> | ||
===Regimen variant #1, brief course {{#subobject:d7858d|Variant=1}}=== | ===Regimen variant #1, brief course {{#subobject:d7858d|Variant=1}}=== | ||
− | {| class="wikitable" style="width: | + | {| class="wikitable sortable" style="width: 60%; text-align:center;" |
− | !style="width: | + | !style="width: 33%"|Study |
− | !style="width: | + | !style="width: 33%"|Dates of enrollment |
+ | !style="width: 33%"|[[Levels_of_Evidence#Evidence|Evidence]] | ||
|- | |- | ||
|[https://doi.org/10.1200/jco.2004.02.047 Loehrer et al. 2004] | |[https://doi.org/10.1200/jco.2004.02.047 Loehrer et al. 2004] | ||
+ | |1998-04 to 2000-11 | ||
|style="background-color:#91cf61"|Phase 2 | |style="background-color:#91cf61"|Phase 2 | ||
|- | |- | ||
Line 326: | Line 359: | ||
<div class="toccolours" style="background-color:#cbd5e7"> | <div class="toccolours" style="background-color:#cbd5e7"> | ||
====Subsequent treatment==== | ====Subsequent treatment==== | ||
− | * | + | *Loehrer et al. 2004, stable disease: [[#Octreotide_.26_Prednisone|octreotide & prednisone]] |
</div></div><br> | </div></div><br> | ||
<div class="toccolours" style="background-color:#eeeeee"> | <div class="toccolours" style="background-color:#eeeeee"> | ||
===Regimen variant #2, extended course {{#subobject:2fffe4|Variant=1}}=== | ===Regimen variant #2, extended course {{#subobject:2fffe4|Variant=1}}=== | ||
− | {| class="wikitable" style="width: | + | {| class="wikitable sortable" style="width: 60%; text-align:center;" |
− | !style="width: | + | !style="width: 33%"|Study |
− | !style="width: | + | !style="width: 33%"|Dates of enrollment |
+ | !style="width: 33%"|[[Levels_of_Evidence#Evidence|Evidence]] | ||
|- | |- | ||
|[https://doi.org/10.1200/jco.2004.02.047 Loehrer et al. 2004] | |[https://doi.org/10.1200/jco.2004.02.047 Loehrer et al. 2004] | ||
+ | |1998-04 to 2000-11 | ||
|style="background-color:#91cf61"|Phase 2 | |style="background-color:#91cf61"|Phase 2 | ||
|- | |- | ||
Line 344: | Line 379: | ||
</div></div> | </div></div> | ||
===References=== | ===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] ''' | + | # 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] '''dosing details in manuscript have been reviewed by our editors''' [https://pubmed.ncbi.nlm.nih.gov/14722038/ PubMed] |
==Octreotide & Prednisone {{#subobject:5a36da|Regimen=1}}== | ==Octreotide & Prednisone {{#subobject:5a36da|Regimen=1}}== | ||
<div class="toccolours" style="background-color:#eeeeee"> | <div class="toccolours" style="background-color:#eeeeee"> | ||
===Regimen {{#subobject:860b16|Variant=1}}=== | ===Regimen {{#subobject:860b16|Variant=1}}=== | ||
− | {| class="wikitable" style="width: | + | {| class="wikitable sortable" style="width: 60%; text-align:center;" |
− | !style="width: | + | !style="width: 33%"|Study |
− | !style="width: | + | !style="width: 33%"|Dates of enrollment |
+ | !style="width: 33%"|[[Levels_of_Evidence#Evidence|Evidence]] | ||
|- | |- | ||
|[https://doi.org/10.1200/jco.2004.02.047 Loehrer et al. 2004] | |[https://doi.org/10.1200/jco.2004.02.047 Loehrer et al. 2004] | ||
+ | |1998-04 to 2000-11 | ||
|style="background-color:#91cf61"|Phase 2 | |style="background-color:#91cf61"|Phase 2 | ||
|- | |- | ||
Line 367: | Line 404: | ||
</div></div> | </div></div> | ||
===References=== | ===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] ''' | + | # 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] '''dosing details in manuscript have been reviewed by our editors''' [https://pubmed.ncbi.nlm.nih.gov/14722038/ PubMed] |
==Sunitinib monotherapy {{#subobject:b3730c|Regimen=1}}== | ==Sunitinib monotherapy {{#subobject:b3730c|Regimen=1}}== | ||
<div class="toccolours" style="background-color:#eeeeee"> | <div class="toccolours" style="background-color:#eeeeee"> | ||
===Regimen {{#subobject:1d254c|Variant=1}}=== | ===Regimen {{#subobject:1d254c|Variant=1}}=== | ||
− | {| class="wikitable" style="width: | + | {| class="wikitable sortable" style="width: 60%; text-align:center;" |
− | !style="width: | + | !style="width: 33%"|Study |
− | !style="width: | + | !style="width: 33%"|Dates of enrollment |
+ | !style="width: 33%"|[[Levels_of_Evidence#Evidence|Evidence]] | ||
|- | |- | ||
|[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4401497/ Thomas et al. 2015 (NCI 12-C-0118)] | |[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4401497/ Thomas et al. 2015 (NCI 12-C-0118)] | ||
+ | |2012-05-15 to 2013-10-02 | ||
|style="background-color:#91cf61"|Phase 2 | |style="background-color:#91cf61"|Phase 2 | ||
|- | |- | ||
Line 385: | Line 424: | ||
</div></div> | </div></div> | ||
===References=== | ===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] ''' | + | # '''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] '''dosing details in manuscript have been reviewed by our editors''' [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4401497/ link to PMC article] [https://pubmed.ncbi.nlm.nih.gov/25592632/ PubMed] [https://clinicaltrials.gov/study/NCT01621568 NCT01621568] |
− | + | ||
− | |||
− | |||
[[Category:Thymoma regimens]] | [[Category:Thymoma regimens]] | ||
[[Category:Disease-specific pages]] | [[Category:Disease-specific pages]] | ||
[[Category:Thoracic cancers]] | [[Category:Thoracic cancers]] |
Latest revision as of 23:33, 24 July 2024
Section editor | |
---|---|
Amit Kulkarni, MBBS University of Minnesota Minneapolis, MN, USA |
14 regimens on this page
16 variants on this page
|
Guidelines
Given the rapid change in evidence in many areas of hematology/oncology, readers are encouraged to consider any guideline published 5+ years ago to be for historical purposes, only.
ESMO
- 2015: Girard et al. Thymic epithelial tumours: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up PubMed
NCCN
Neoadjuvant therapy for borderline resectable disease
PAC-P
PAC: Platinol (Cisplatin), Adriamycin (Doxorubicin), Cyclophosphamide
CAP: Cyclophosphamide, Adriamycin (Doxorubicin), Platinol (Cisplatin)
Regimen
Study | Dates of enrollment | Evidence |
---|---|---|
Kim et al. 2004 | 1990-02 to 2000-04 | 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, and has been renamed PAC-P here.
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 adjuvant 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 dosing details in manuscript have been reviewed by our editors PubMed
Adjuvant therapy
PAC-P
PAC: Platinol (Cisplatin), Adriamycin (Doxorubicin), Cyclophosphamide
CAP: Cyclophosphamide, Adriamycin (Doxorubicin), Platinol (Cisplatin)
Regimen
Study | Dates of enrollment | Evidence |
---|---|---|
Kim et al. 2004 | 1990-02 to 2000-04 | 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, and has been renamed PAC-P, here. Also note that these doses are 80% of the induction doses, except for the prednisone.
Preceding treatment
- Definitive 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 dosing details in manuscript have been reviewed by our editors PubMed
Radiation therapy
Regimen
Study | Dates of enrollment | Evidence |
---|---|---|
Kim et al. 2004 | 1990-02 to 2000-04 | Phase 2 |
Radiotherapy
- External beam radiotherapy by the following response-based criteria:
- If tumor is completely resected and has at least 80% necrosis: 5000 cGy is administered 3 to 6 weeks after surgery
- If tumor is incompletely resected or has less than 80% necrosis: 6000 cGy is administered
One course
Subsequent treatment
- Adjuvant PAC-P 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 dosing details in manuscript have been reviewed by our editors PubMed
Advanced or metastatic disease, first-line therapy
ADOC
ADOC: Adriamycin (Doxorubicin), cis-Diamminedichloroplatinum (Cisplatin), Oncovin (Vincristine), Cyclophosphamide
Regimen
Study | Dates of enrollment | Evidence |
---|---|---|
Fornasiero et al. 1991 | 1977-1990 | 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 dosing details in manuscript have been reviewed by our editors PubMed
Carboplatin & Paclitaxel (CP)
Regimen
Study | Dates of enrollment | Evidence |
---|---|---|
Lemma et al. 2011 | 2001-02 to 2008-01 | 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
- Diphenhydramine (Benadryl) 25 mg IV once on day 1; 60 minutes prior to paclitaxel
- Dexamethasone (Decadron) 20 mg IV once on day 1; 60 minutes prior to paclitaxel
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 dosing details in manuscript have been reviewed by our editors link to PMC article PubMed
CISCA
CISCA: CISplatin, Cyclophosphamide, Adriamycin (Doxorubicin)
PAC: Platinol (Cisplatin), Adriamycin (Doxorubicin), Cyclophosphamide
CAP: Cyclophosphamide, Adriamycin (Doxorubicin), Platinol (Cisplatin)
Regimen
Study | Dates of enrollment | Evidence |
---|---|---|
Loehrer et al. 1990 | 1983-04 to 1988-03 | 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 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 dosing details in manuscript have been reviewed by our editors 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. link to original article dosing details in manuscript have been reviewed by our editors PubMed
Cisplatin & Etoposide (EP)
PE: Platinol (Cisplatin), Etoposide
Regimen
Study | Dates of enrollment | Evidence |
---|---|---|
Giaccone et al. 1996 | 1985-09 to 1991-08 | 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 dosing details in manuscript have been reviewed by our editors PubMed
VIP
VIP: Vepesid (Etoposide), Ifosfamide, Platinol (Cisplatin)
Regimen
Study | Dates of enrollment | Evidence |
---|---|---|
Loehrer et al. 2001 | 1995-07 to 1997-02 | 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 (total dose per cycle: 1920 mg/m2)
- 1 liter normal saline once per day on days 1 to 4, prior to cisplatin
- 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 dosing details in manuscript have been reviewed by our editors PubMed
Advanced or metastatic disease, subsequent lines of therapy
Capecitabine & Gemcitabine
CAP-GEM: CAPecitabine & GEMcitabine
Regimen
Study | Dates of enrollment | Evidence | Efficacy |
---|---|---|---|
Palmieri et al. 2009 | 2005-11 to 2008-08 | 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
- 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 dosing details in abstract have been reviewed by our editors PubMed
Everolimus monotherapy
Regimen
Study | Dates of enrollment | Evidence | Efficacy |
---|---|---|---|
Zucali et al. 2017 (ONC-2010-001) | 2011-02-17 to 2013-10-21 | Phase 2 | DCR: 88% |
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 dosing details in manuscript have been reviewed by our editors PubMed
Ifosfamide monotherapy
Regimen variant #1, intermittent dosing
Study | Dates of enrollment | Evidence |
---|---|---|
Highley et al. 1999 | 1984-07 to 1996-07 | Pilot, fewer than 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 | Dates of enrollment | Evidence |
---|---|---|
Highley et al. 1999 | 1984-07 to 1996-07 | Pilot, fewer than 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 dosing details in manuscript have been reviewed by our editors PubMed content property of HemOnc.org
Octreotide monotherapy
Regimen variant #1, brief course
Study | Dates of enrollment | Evidence |
---|---|---|
Loehrer et al. 2004 | 1998-04 to 2000-11 | Phase 2 |
Subsequent treatment
- Loehrer et al. 2004, stable disease: octreotide & prednisone
Regimen variant #2, extended course
Study | Dates of enrollment | Evidence |
---|---|---|
Loehrer et al. 2004 | 1998-04 to 2000-11 | 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 dosing details in manuscript have been reviewed by our editors PubMed
Octreotide & Prednisone
Regimen
Study | Dates of enrollment | Evidence |
---|---|---|
Loehrer et al. 2004 | 1998-04 to 2000-11 | 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 dosing details in manuscript have been reviewed by our editors PubMed
Sunitinib monotherapy
Regimen
Study | Dates of enrollment | Evidence |
---|---|---|
Thomas et al. 2015 (NCI 12-C-0118) | 2012-05-15 to 2013-10-02 | Phase 2 |
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 dosing details in manuscript have been reviewed by our editors link to PMC article PubMed NCT01621568