Difference between revisions of "Thymoma"
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{{TOC limit|limit=3}} | {{TOC limit|limit=3}} | ||
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=Guidelines= | =Guidelines= | ||
==[http://www.esmo.org/ ESMO]== | ==[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] | *'''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] | ||
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==[https://www.nccn.org/ NCCN]== | ==[https://www.nccn.org/ NCCN]== | ||
*[https://www.nccn.org/professionals/physician_gls/pdf/thymic.pdf NCCN Guidelines - Thymomas and Thymic Carcinomas] | *[https://www.nccn.org/professionals/physician_gls/pdf/thymic.pdf NCCN Guidelines - Thymomas and Thymic Carcinomas] | ||
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=Neoadjuvant therapy for borderline resectable disease= | =Neoadjuvant therapy for borderline resectable disease= | ||
==PAC {{#subobject:96fd1b|Regimen=1}}== | ==PAC {{#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"> | ||
===Regimen {{#subobject:dcf948|Variant=1}}=== | ===Regimen {{#subobject:dcf948|Variant=1}}=== | ||
{| class="wikitable" style="width: 40%; text-align:center;" | {| class="wikitable" style="width: 40%; text-align:center;" | ||
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''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.'' | ||
+ | <div class="toccolours" style="background-color:#b3e2cd"> | ||
====Chemotherapy==== | ====Chemotherapy==== | ||
*[[Cisplatin (Platinol)]] 30 mg/m<sup>2</sup> IV once per day on days 1 to 3 | *[[Cisplatin (Platinol)]] 30 mg/m<sup>2</sup> IV once per day on days 1 to 3 | ||
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====Glucocorticoid therapy==== | ====Glucocorticoid therapy==== | ||
*[[Prednisone (Sterapred)]] 100 mg PO once per day on days 1 to 5 | *[[Prednisone (Sterapred)]] 100 mg PO once per day on days 1 to 5 | ||
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====Supportive therapy==== | ====Supportive therapy==== | ||
*[[Metoclopramide (Reglan)]] 1 mg/kg IV once per day on days 1 to 3, prior to chemotherapy | *[[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 | *[[Diphenhydramine (Benadryl)]] 25 mg IV once per day on days 1 to 3, prior to chemotherapy | ||
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'''21- to 28-day cycle for 3 cycles''' | '''21- to 28-day cycle for 3 cycles''' | ||
+ | </div> | ||
+ | <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 [[#PAC_2|PAC]] consolidation | *[[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=== | ===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] | # 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] | ||
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=Adjuvant therapy= | =Adjuvant therapy= | ||
==PAC {{#subobject:76239f|Regimen=1}}== | ==PAC {{#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"> | ||
===Regimen {{#subobject:adbf18|Variant=1}}=== | ===Regimen {{#subobject:adbf18|Variant=1}}=== | ||
{| class="wikitable" style="width: 40%; text-align:center;" | {| class="wikitable" style="width: 40%; text-align:center;" | ||
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|} | |} | ||
''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. Also note that these doses are 80% of the induction doses, except for the prednisone.'' | ||
+ | <div class="toccolours" style="background-color:#cbd5e8"> | ||
====Preceding treatment==== | ====Preceding treatment==== | ||
*[[#Radiation_therapy|RT]] | *[[#Radiation_therapy|RT]] | ||
+ | </div> | ||
+ | <div class="toccolours" style="background-color:#b3e2cd"> | ||
====Chemotherapy==== | ====Chemotherapy==== | ||
*[[Cisplatin (Platinol)]] 24 mg/m<sup>2</sup> IV once per day on days 1 to 3 | *[[Cisplatin (Platinol)]] 24 mg/m<sup>2</sup> IV once per day on days 1 to 3 | ||
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====Glucocorticoid therapy==== | ====Glucocorticoid therapy==== | ||
*[[Prednisone (Sterapred)]] 100 mg PO once per day on days 1 to 5 | *[[Prednisone (Sterapred)]] 100 mg PO once per day on days 1 to 5 | ||
− | |||
'''21- to 28-day cycle for 3 cycles''' | '''21- to 28-day cycle for 3 cycles''' | ||
− | + | </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] '''contains dosing details in manuscript''' [https://pubmed.ncbi.nlm.nih.gov/15140551 PubMed] | # 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] | ||
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==Radiation therapy {{#subobject:afc56b|Regimen=1}}== | ==Radiation therapy {{#subobject:afc56b|Regimen=1}}== | ||
− | + | <div class="toccolours" style="background-color:#eeeeee"> | |
===Regimen {{#subobject:07cb87|Variant=1}}=== | ===Regimen {{#subobject:07cb87|Variant=1}}=== | ||
{| class="wikitable" style="width: 40%; text-align:center;" | {| class="wikitable" style="width: 40%; text-align:center;" | ||
Line 91: | Line 89: | ||
|- | |- | ||
|} | |} | ||
+ | <div class="toccolours" style="background-color:#cbd5e8"> | ||
====Preceding treatment==== | ====Preceding treatment==== | ||
*[[#PAC|PAC]] induction, then [[Surgery#Thymectomy|surgery]] (in some cases) | *[[#PAC|PAC]] induction, then [[Surgery#Thymectomy|surgery]] (in some cases) | ||
− | + | </div> | |
+ | <div class="toccolours" style="background-color:#b3e2cd"> | ||
====Radiotherapy==== | ====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 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 | *If tumor is incompletely resected or has less than 80% necrosis: 60 Gy [[External beam radiotherapy]] is administered | ||
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'''One course''' | '''One course''' | ||
+ | </div> | ||
+ | <div class="toccolours" style="background-color:#cbd5e7"> | ||
====Subsequent treatment==== | ====Subsequent treatment==== | ||
*[[#PAC_2|PAC]] x 3 | *[[#PAC_2|PAC]] x 3 | ||
− | + | </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] '''contains dosing details in manuscript''' [https://pubmed.ncbi.nlm.nih.gov/15140551 PubMed] | # 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] | ||
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=Advanced or metastatic disease, first-line therapy= | =Advanced or metastatic disease, first-line therapy= | ||
==ADOC {{#subobject:a329b4|Regimen=1}}== | ==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 | 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}}=== | ===Regimen {{#subobject:ee5c1b|Variant=1}}=== | ||
{| class="wikitable" style="width: 40%; text-align:center;" | {| 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.'' | ''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==== | ====Chemotherapy==== | ||
*[[Doxorubicin (Adriamycin)]] 40 mg/m<sup>2</sup> IV once on day 1 | *[[Doxorubicin (Adriamycin)]] 40 mg/m<sup>2</sup> IV once on day 1 | ||
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*[[Vincristine (Oncovin)]] 0.6 mg/m<sup>2</sup> IV once on day 3 | *[[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 | *[[Cyclophosphamide (Cytoxan)]] 700 mg/m<sup>2</sup> IV once on day 4 | ||
− | |||
'''21- to 28-day cycles''' | '''21- to 28-day cycles''' | ||
− | + | </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. 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] | # '''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] | ||
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==Carboplatin & Paclitaxel (CP) {{#subobject:410ff6|Regimen=1}}== | ==Carboplatin & Paclitaxel (CP) {{#subobject:410ff6|Regimen=1}}== | ||
− | + | <div class="toccolours" style="background-color:#eeeeee"> | |
===Regimen {{#subobject:34b20a|Variant=1}}=== | ===Regimen {{#subobject:34b20a|Variant=1}}=== | ||
{| class="wikitable" style="width: 40%; text-align:center;" | {| class="wikitable" style="width: 40%; text-align:center;" | ||
Line 141: | Line 140: | ||
|- | |- | ||
|} | |} | ||
+ | <div class="toccolours" style="background-color:#b3e2cd"> | ||
====Chemotherapy==== | ====Chemotherapy==== | ||
*[[Carboplatin (Paraplatin)]] AUC 6 IV over 30 minutes once on day 1, '''given second''' | *[[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''' | *[[Paclitaxel (Taxol)]] 225 mg/m<sup>2</sup> IV over 3 hours once on day 1, '''given first''' | ||
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====Supportive therapy==== | ====Supportive therapy==== | ||
*[[Cimetidine (Tagamet)]] 300 mg IV once on day 1; 60 minutes prior to [[Paclitaxel (Taxol)]] | *[[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)]] | *[[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)]] | *[[Dexamethasone (Decadron)]] 20 mg IV once on day 1; 60 minutes prior to [[Paclitaxel (Taxol)]] | ||
− | |||
'''21-day cycle for up to 6 cycles''' | '''21-day cycle for up to 6 cycles''' | ||
− | + | </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] '''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] | # 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] | ||
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==Cisplatin & Etoposide (EP) {{#subobject:2355da|Regimen=1}}== | ==Cisplatin & Etoposide (EP) {{#subobject:2355da|Regimen=1}}== | ||
− | |||
PE: '''<u>P</u>'''latinol (Cisplatin), '''<u>E</u>'''toposide | PE: '''<u>P</u>'''latinol (Cisplatin), '''<u>E</u>'''toposide | ||
+ | <div class="toccolours" style="background-color:#eeeeee"> | ||
===Regimen {{#subobject:906dfc|Variant=1}}=== | ===Regimen {{#subobject:906dfc|Variant=1}}=== | ||
{| class="wikitable" style="width: 40%; text-align:center;" | {| class="wikitable" style="width: 40%; text-align:center;" | ||
Line 167: | Line 164: | ||
|- | |- | ||
|} | |} | ||
+ | <div class="toccolours" style="background-color:#b3e2cd"> | ||
====Chemotherapy==== | ====Chemotherapy==== | ||
*[[Cisplatin (Platinol)]] 60 mg/m<sup>2</sup> IV over 60 minutes once on day 1 | *[[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 | *[[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" | *"A program of forced hydration" | ||
− | |||
'''21-day cycle for up to 8 cycles''' | '''21-day cycle for up to 8 cycles''' | ||
− | + | </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] '''contains dosing details in manuscript''' [https://pubmed.ncbi.nlm.nih.gov/8622029 PubMed] | # 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 {{#subobject:ce7f87|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"> | ||
===Regimen {{#subobject:f15804|Variant=1}}=== | ===Regimen {{#subobject:f15804|Variant=1}}=== | ||
{| class="wikitable" style="width: 40%; text-align:center;" | {| class="wikitable" style="width: 40%; text-align:center;" | ||
Line 192: | Line 187: | ||
|- | |- | ||
|} | |} | ||
+ | <div class="toccolours" style="background-color:#b3e2cd"> | ||
====Chemotherapy==== | ====Chemotherapy==== | ||
*[[Cisplatin (Platinol)]] 50 mg/m<sup>2</sup> IV over at least 1 hour once on day 1 | *[[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 | *[[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 | *[[Cyclophosphamide (Cytoxan)]] 500 mg/m<sup>2</sup> IV slow push once on day 1 | ||
− | |||
====Supportive therapy==== | ====Supportive therapy==== | ||
*1 liter NS over 2 hours at least 2 hours before and after [[Cisplatin (Platinol)]] 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 | *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> | |
===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] '''contains dosing details in manuscript''' [https://pubmed.ncbi.nlm.nih.gov/2203292 PubMed] | # 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] | ## '''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 {{#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"> | ||
===Regimen {{#subobject:2235f2|Variant=1}}=== | ===Regimen {{#subobject:2235f2|Variant=1}}=== | ||
{| class="wikitable" style="width: 40%; text-align:center;" | {| class="wikitable" style="width: 40%; text-align:center;" | ||
Line 219: | Line 212: | ||
|- | |- | ||
|} | |} | ||
+ | <div class="toccolours" style="background-color:#b3e2cd"> | ||
====Chemotherapy==== | ====Chemotherapy==== | ||
*[[Etoposide (Vepesid)]] 75 mg/m<sup>2</sup> IV once per day on days 1 to 4 | *[[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 | *[[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 | *[[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 [[Ifosfamide (Ifex)]] (total dose per cycle: 1920 mg/m<sup>2</sup>) | *[[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)]] | *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 | *[[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> | |
===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] '''contains dosing details in manuscript''' [https://pubmed.ncbi.nlm.nih.gov/11391579 PubMed] | # 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= | =Advanced or metastatic disease, subsequent lines of therapy= | ||
==Capecitabine & Gemcitabine {{#subobject:cabb5e|Regimen=1}}== | ==Capecitabine & Gemcitabine {{#subobject:cabb5e|Regimen=1}}== | ||
− | |||
CAP-GEM: '''<u>CAP</u>'''ecitabine & '''<u>GEM</u>'''citabine | CAP-GEM: '''<u>CAP</u>'''ecitabine & '''<u>GEM</u>'''citabine | ||
+ | <div class="toccolours" style="background-color:#eeeeee"> | ||
===Regimen {{#subobject:335173|Variant=1}}=== | ===Regimen {{#subobject:335173|Variant=1}}=== | ||
{| class="wikitable" style="width: 60%; text-align:center;" | {| class="wikitable" style="width: 60%; text-align:center;" | ||
Line 249: | Line 240: | ||
|- | |- | ||
|} | |} | ||
+ | <div class="toccolours" style="background-color:#b3e2cd"> | ||
====Chemotherapy==== | ====Chemotherapy==== | ||
*[[Capecitabine (Xeloda)]] 650 mg/m<sup>2</sup> PO twice per day on days 1 to 14 | *[[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 | *[[Gemcitabine (Gemzar)]] 1000 mg/m<sup>2</sup> IV once per day on days 1 & 8 | ||
− | |||
'''21-day cycles''' | '''21-day cycles''' | ||
− | + | </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. [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] | ## '''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}}== | ==Everolimus monotherapy {{#subobject:e7a59f|Regimen=1}}== | ||
− | + | <div class="toccolours" style="background-color:#eeeeee"> | |
===Regimen {{#subobject:82c282|Variant=1}}=== | ===Regimen {{#subobject:82c282|Variant=1}}=== | ||
{| class="wikitable" style="width: 60%; text-align:center;" | {| class="wikitable" style="width: 60%; text-align:center;" | ||
Line 272: | Line 262: | ||
|- | |- | ||
|} | |} | ||
+ | <div class="toccolours" style="background-color:#b3e2cd"> | ||
====Targeted therapy==== | ====Targeted therapy==== | ||
*[[Everolimus (Afinitor)]] 10 mg PO once per day | *[[Everolimus (Afinitor)]] 10 mg PO once per day | ||
− | |||
'''Continued indefinitely''' | '''Continued indefinitely''' | ||
− | + | </div></div> | |
===References=== | ===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] --> | # '''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] | # '''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}}== | ==Ifosfamide monotherapy {{#subobject:69edc9|Regimen=1}}== | ||
− | + | <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: 40%; text-align:center;" | {| class="wikitable" style="width: 40%; text-align:center;" | ||
Line 293: | Line 282: | ||
|- | |- | ||
|} | |} | ||
+ | <div class="toccolours" style="background-color:#b3e2cd"> | ||
====Chemotherapy==== | ====Chemotherapy==== | ||
*[[Ifosfamide (Ifex)]] 1500 mg/m<sup>2</sup> IV over 30 minutes once per day on days 1 to 5 | *[[Ifosfamide (Ifex)]] 1500 mg/m<sup>2</sup> IV over 30 minutes once per day on days 1 to 5 | ||
− | |||
====Supportive therapy==== | ====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>) | *[[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''' | '''21-day cycles''' | ||
− | + | </div></div><br> | |
+ | <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: 40%; text-align:center;" | {| class="wikitable" style="width: 40%; text-align:center;" | ||
Line 310: | Line 299: | ||
|- | |- | ||
|} | |} | ||
+ | <div class="toccolours" style="background-color:#b3e2cd"> | ||
====Chemotherapy==== | ====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>) | *[[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==== | ====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>) | *[[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''' | '''21-day cycles''' | ||
− | + | </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] '''contains dosing details in manuscript''' [https://pubmed.ncbi.nlm.nih.gov/10561348 PubMed] content property of [http://hemonc.org HemOnc.org] | # 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}}== | ==Octreotide monotherapy {{#subobject:109390|Regimen=1}}== | ||
− | + | <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: 40%; text-align:center;" | {| 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] | |[https://doi.org/10.1200/jco.2004.02.047 Loehrer et al. 2004] | ||
|style="background-color:#91cf61"|Phase 2 | |style="background-color:#91cf61"|Phase 2 | ||
− | |||
|- | |- | ||
|} | |} | ||
+ | <div class="toccolours" style="background-color:#b3e2cd"> | ||
====Endocrine therapy==== | ====Endocrine therapy==== | ||
*[[Octreotide (Sandostatin)]] 0.5 mg SC three times per day | *[[Octreotide (Sandostatin)]] 0.5 mg SC three times per day | ||
− | |||
'''1-month cycle for 2 cycles''' | '''1-month cycle for 2 cycles''' | ||
+ | </div> | ||
+ | <div class="toccolours" style="background-color:#cbd5e7"> | ||
====Subsequent treatment==== | ====Subsequent treatment==== | ||
*If stable disease, patients would transition to [[#Octreotide_.26_Prednisone|octreotide & prednisone]] | *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}}=== | ===Regimen variant #2, extended course {{#subobject:2fffe4|Variant=1}}=== | ||
{| class="wikitable" style="width: 40%; text-align:center;" | {| class="wikitable" style="width: 40%; text-align:center;" | ||
Line 349: | Line 338: | ||
|- | |- | ||
|} | |} | ||
+ | <div class="toccolours" style="background-color:#b3e2cd"> | ||
====Endocrine therapy==== | ====Endocrine therapy==== | ||
*[[Octreotide (Sandostatin)]] 0.5 mg SC three times per day | *[[Octreotide (Sandostatin)]] 0.5 mg SC three times per day | ||
− | |||
'''1-month cycle for up to 12 cycles''' | '''1-month cycle for up to 12 cycles''' | ||
− | + | </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] '''contains dosing details in manuscript''' [https://pubmed.ncbi.nlm.nih.gov/14722038 PubMed] | # 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}}== | ==Octreotide & Prednisone {{#subobject:5a36da|Regimen=1}}== | ||
− | + | <div class="toccolours" style="background-color:#eeeeee"> | |
===Regimen {{#subobject:860b16|Variant=1}}=== | ===Regimen {{#subobject:860b16|Variant=1}}=== | ||
{| class="wikitable" style="width: 40%; text-align:center;" | {| class="wikitable" style="width: 40%; text-align:center;" | ||
Line 368: | Line 356: | ||
|- | |- | ||
|} | |} | ||
+ | <div class="toccolours" style="background-color:#cbd5e8"> | ||
====Preceding treatment==== | ====Preceding treatment==== | ||
*[[#Octreotide_monotherapy|Octreotide]] x 2 mo | *[[#Octreotide_monotherapy|Octreotide]] x 2 mo | ||
+ | </div> | ||
+ | <div class="toccolours" style="background-color:#b3e2cd"> | ||
====Endocrine therapy==== | ====Endocrine therapy==== | ||
*[[Octreotide (Sandostatin)]] 0.5 mg SC three times per day | *[[Octreotide (Sandostatin)]] 0.5 mg SC three times per day | ||
*[[Prednisone (Sterapred)]] 0.6 mg/kg PO once per day | *[[Prednisone (Sterapred)]] 0.6 mg/kg PO once per day | ||
− | |||
'''1-month cycle for up to 10 cycles''' | '''1-month cycle for up to 10 cycles''' | ||
− | + | </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] '''contains dosing details in manuscript''' [https://pubmed.ncbi.nlm.nih.gov/14722038 PubMed] | # 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}}== | ==Sunitinib monotherapy {{#subobject:b3730c|Regimen=1}}== | ||
− | + | <div class="toccolours" style="background-color:#eeeeee"> | |
===Regimen {{#subobject:1d254c|Variant=1}}=== | ===Regimen {{#subobject:1d254c|Variant=1}}=== | ||
{| class="wikitable" style="width: 40%; text-align:center;" | {| class="wikitable" style="width: 40%; text-align:center;" | ||
Line 390: | Line 379: | ||
|- | |- | ||
|} | |} | ||
+ | <div class="toccolours" style="background-color:#b3e2cd"> | ||
====Targeted therapy==== | ====Targeted therapy==== | ||
*[[Sunitinib (Sutent)]] 50 mg PO once per day on days 1 to 28 | *[[Sunitinib (Sutent)]] 50 mg PO once per day on days 1 to 28 | ||
− | |||
'''42-day cycles''' | '''42-day cycles''' | ||
− | + | </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] '''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 | # '''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= | =Investigational agents= | ||
''Drugs with preliminary evidence of efficacy in this disease subtype.'' | ''Drugs with preliminary evidence of efficacy in this disease subtype.'' | ||
*[[Cixutumumab (IMC-A12)]] | *[[Cixutumumab (IMC-A12)]] | ||
− | |||
[[Category:Thymoma regimens]] | [[Category:Thymoma regimens]] | ||
[[Category:Disease-specific pages]] | [[Category:Disease-specific pages]] | ||
[[Category:Thoracic cancers]] | [[Category:Thoracic cancers]] |
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
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
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 |
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
- 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
- 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% |
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 |
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 |
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.