Difference between revisions of "Thymoma"

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Supportive medications:
 
Supportive medications:
 
*Metoclopramide (Reglan) 1 mg/kg IV prior to chemotherapy
 
*Metoclopramide (Reglan) 1 mg/kg IV prior to chemotherapy
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*Diphendyramine (Benadryl) 25 mg IV prior to chemotherapy
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*Diphenhydramine (Benadryl) 25 mg IV prior to chemotherapy
  
 
*Surgical resection is performed if CT scan 3-4 weeks after the third cycle of chemotherapy shows disease amenable resection
 
*Surgical resection is performed if CT scan 3-4 weeks after the third cycle of chemotherapy shows disease amenable resection

Revision as of 04:46, 3 July 2012

Use of this site is subject to you reading and agreeing with the terms set forth in the disclaimer.

Is there a regimen missing from this list? Would you like to share a different dosage/schedule or an additional reference for a regimen? Have you noticed an error? Do you have an idea that will help the site grow to better meet your needs and the needs of many others? You are invited to contribute to the site.


First-line therapy

ADOC

ADOC: Adriamycin, cis-Diamminedichloroplatinum, Oncovin, Cyclophosphamide

Regimen

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 the NCCN, Thymomas and Thymic Carcinomas version 2.2012, lists the regimen as being given every 4 weeks.

21 to 28-day cycles--see note above regarding duration of cycles

References

  1. 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 verified protocol PubMed

Carboplatin (Paraplatin) & Paclitaxel (Taxol)

Regimen

21-day cycles x up to 6 cycles

Supportive medications:

  • Cimetidine (Tagamet) 300 mg IV 1 hour prior to paclitaxel
  • Diphenhydramine (Benadryl) 25 mg IV 1 hour prior to paclitaxel
  • Dexamethasone (Decadron) 20 mg IV 1 hour prior to paclitaxel

References

  1. 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 verified protocol PubMed

PAC (CAP)

PAC: Platinol, Adriamycin, Cyclophosphamide
CAP: Cyclophosphamide, Adriamycin, Platinol

Regimen

21-day cycles x up to 8 cycles

Supportive medications:

  • 1 liter normal saline 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

References

  1. Loehrer PJ Sr, Kim K, Aisner SC, Livingston R, Einhorn LH, Johnson D, Blum R. Cisplatin plus doxorubicin plus cyclophosphamide in metastatic or recurrent thymoma: final results of an intergroup trial. The Eastern Cooperative Oncology Group, Southwest Oncology Group, and Southeastern Cancer Study Group. J Clin Oncol. 1994 Jun;12(6):1164-8. link to original article contains verified protocol PubMed

PAC, Prednisone (Sterapred), surgery, RT, chemo

PAC: Platinol, Adriamycin, Cyclophosphamide

Regimen

Note: The NCCN, Thymomas and Thymic Carcinomas version 2.2012, lists only the induction phase of this regimen under its first-line options. No primary reference could be found for treatment with only the induction phase of therapy.
Induction phase:

21 to 28-day cycles x 3 cycles

Supportive medications:

  • Metoclopramide (Reglan) 1 mg/kg IV prior to chemotherapy
  • Diphenhydramine (Benadryl) 25 mg IV prior to chemotherapy
  • Surgical resection is performed if CT scan 3-4 weeks after the third cycle of chemotherapy shows disease amenable resection
  • If tumor is completely resected and has at least 80% necrosis, 50 Gy radiation therapy is administered 3-6 weeks after surgery
    • If tumor is incompletely resected or has <80% necrosis, 60 Gy radiation therapy is administered

Consolidation phase (at 80% of the induction doses of cisplatin, doxorubicin, and cyclophosphamide; 100% dose of prednisone):

21 to 28-day cycles x 3 cycles

References

  1. 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 verified protocol PubMed

PE

PE: Platinol, Etoposide

Regimen

21-day cycles x up to 8 cycles

Supportive medications:

  • "A program of forced hydration"

References

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

VIP

VIP: Vepesid, Ifosfamide, Platinol

Regimen

21-day cycles x 4 cycles

Supportive medications:

  • 1 liter normal saline prior to cisplatin
  • Filgrastim (Neupogen) 5 mcg/kg SC on days 5-15, until WBC at least 10,000 postnadir

References

  1. 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 verified protocol PubMed

Second-line therapy

Ifosfamide (Ifex)

Regimen #1, Highley, et al. 1999

  • Ifosfamide (Ifex) 1500 mg/m2 IV over 30 minutes on days 1-5
  • Mesna (Mesnex) 400 mg IV bolus before ifosfamide, then Mesna (Mesnex) 1000 mg/m2 in 1 liter NS IV over 7.5 hours after ifosfamide on days 1-5

21-day cycles

Regimen #2, Highley, et al. 1999

  • Mesna (Mesnex) 2000 mg IV bolus on day 1, given first
  • A 3 liter solution of D5NS containing the following is then given IV continuous 24-hour infusion on days 1-5
  • Mesna (Mesnex) 1500 mg/m2/day in 3 liters of D5NS IV continuous 24-hour infusion on days 6-8

21-day cycles

References

  1. 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 verified protocol PubMed content property of HemOnc.org

Octreotide (Sandostatin)

Regimen

1-month cycles x up to 12 cycles

References

  1. Loehrer PJ Sr, Wang W, Johnson DH, Aisner SC, Ettinger DS; Eastern Cooperative Oncology Group Phase II Trial. 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 verified protocol PubMed

Octreotide (Sandostatin) & Prednisone (Sterapred)

Regimen

1-month cycles x 2 cycles

If stable disease after 2 cycles, patients would then receive:

1-month cycles x up to 10 additional cycles

References

  1. Loehrer PJ Sr, Wang W, Johnson DH, Aisner SC, Ettinger DS; Eastern Cooperative Oncology Group Phase II Trial. 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 verified protocol PubMed
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