Thymoma
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14 regimens on this page
16 variants on this page
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Guidelines
ESMO
- Thymic epithelial tumours: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. (2015) PubMed
NCCN
Neoadjuvant therapy for borderline resectable disease
PAC & Prednisone
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PAC: Platinol (Cisplatin), Adriamycin (Doxorubicin), Cyclophosphamide
CAP: Cyclophosphamide, Adriamycin (Doxorubicin), Platinol (Cisplatin)
Regimen
Study | Evidence |
Kim et al. 2004 | Phase II |
Chemotherapy
- Cisplatin (Platinol) 30 mg/m2 IV once per day on days 1 to 3
- Doxorubicin (Adriamycin) 20 mg/m2/day IV continuous infusion on days 1 to 3 (total dose: 60 mg/m2)
- Cyclophosphamide (Cytoxan) 500 mg/m2 IV by slow injection or infusion once on day 1
- Prednisone (Sterapred) 100 mg PO once per day on days 1 to 5
Supportive medications
- Metoclopramide (Reglan) 1 mg/kg IV prior to chemotherapy
- Diphenhydramine (Benadryl) 25 mg IV prior to chemotherapy
21 to 28-day cycle for 3 cycles
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 & prednisone 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 verified protocol PubMed
Adjuvant chemoradiotherapy
RT, then PAC & Prednisone
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PAC: Platinol (Cisplatin), Adriamycin (Doxorubicin), Cyclophosphamide
CAP: Cyclophosphamide, Adriamycin (Doxorubicin), Platinol (Cisplatin)
Regimen
Study | Evidence |
Kim et al. 2004 | Phase II |
Treatment preceded by PAC & prednisone induction and surgery (in some cases).
Radiotherapy
- If tumor is completely resected and has at least 80% necrosis, 50 Gy radiation therapy is administered 3 to 6 weeks after surgery
- If tumor is incompletely resected or has less than 80% necrosis, 60 Gy radiation therapy is administered
One course, followed by consolidation:
Chemotherapy
- Cisplatin (Platinol) 24 mg/m2 IV once per day on days 1 to 3
- Doxorubicin (Adriamycin) 16 mg/m2/day IV continuous infusion on days 1 to 3 (total dose: 48 mg/m2)
- Cyclophosphamide (Cytoxan) 400 mg/m2 IV by slow injection or infusion once on day 1
- 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 verified protocol PubMed
Advanced or metastatic disease, first-line therapy
ADOC
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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 the NCCN, Thymomas and Thymic Carcinomas version 2.2012, lists 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--see note above regarding duration of 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 verified protocol PubMed
Carboplatin & Paclitaxel
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Regimen
Study | Evidence |
Lemma et al. 2011 | Phase II |
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 medications
- Cimetidine (Tagamet) 300 mg IV 1 hour prior to Paclitaxel (Taxol)
- Diphenhydramine (Benadryl) 25 mg IV 1 hour prior to Paclitaxel (Taxol)
- Dexamethasone (Decadron) 20 mg IV 1 hour 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 verified protocol link to PMC article PubMed
PAC
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PAC: Platinol (Cisplatin), Adriamycin (Doxorubicin), Cyclophosphamide
CAP: Cyclophosphamide, Adriamycin (Doxorubicin), Platinol (Cisplatin)
Regimen
Study | Evidence |
Loehrer et al. 1990 | Phase II |
Chemotherapy
- Cisplatin (Platinol) 50 mg/m2 IV over at least 1 hour once on day 1
- Doxorubicin (Adriamycin) 50 mg/m2 IV by slow injection once on day 1
- Cyclophosphamide (Cytoxan) 500 mg/m2 IV by slow injection or infusion once on day 1
Supportive medications
- 1 liter normal saline 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 verified protocol PubMed
- Update: 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
PE
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PE: Platinol (Cisplatin), Etoposide
Regimen
Study | Evidence |
Giaccone et al. 1996 | Phase II |
Chemotherapy
- Cisplatin (Platinol) 60 mg/m2 IV over 1 hour once on day 1
- Etoposide (Vepesid) 120 mg/m2 IV over at least 30 minutes once per day on days 1 to 3
Supportive medications
- "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. 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
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VIP: Vepesid (Etoposide), Ifosfamide, Platinol (Cisplatin)
Regimen
Study | Evidence |
Loehrer et al. 2001 | Phase II |
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 medications
- Mesna (Mesnex) 240 mg/m2 IV push before, 4 hours after, and 8 hours after Ifosfamide (Ifex) once per day on days 1 to 4
- 1 liter normal saline 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 verified protocol PubMed
Advanced or metastatic disease, second-line therapy
Capecitabine & Gemcitabine
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CAP-GEM: CAPecitabine & GEMcitabine
Regimen
Study | Evidence |
Palmieri et al. 2009 | Phase II |
Chemotherapy
- Capecitabine (Xeloda) 650 mg/m2 PO BID 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 protocol PubMed
Everolimus monotherapy
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Regimen
Study | Evidence |
Zucali et al. 2014 | Phase II |
Chemotherapy
- Everolimus (Afinitor) 10 mg PO once per day
Continued until progression or intolerance
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. link to abstract
Ifosfamide monotherapy
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Regimen #1
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 medications
- Mesna (Mesnex) 400 mg IV bolus before ifosfamide, then 1000 mg/m2 in 1 liter NS IV over 7.5 hours after ifosfamide once per day on days 1 to 5
21-day cycles
Regimen #2
Study | Evidence |
Highley et al. 1999 | Pilot, <20 pts |
Chemotherapy
- Ifosfamide (Ifex) 1500 mg/m2/day IV continuous infusion on days 1 to 5
Supportive medications
- Mesna (Mesnex) as follows:
- Day 1: 2000 mg IV bolus on day 1, given first
- Days 1 to 5: 1500 mg/m2/day in 3 liters of D5NS IV continuous infusion
- Days 6 to 8: 1500 mg/m2/day in 3 liters of D5NS IV continuous infusion
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 verified protocol PubMed content property of HemOnc.org
Octreotide monotherapy
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Regimen
Study | Evidence |
Loehrer et al. 2004 | Phase II |
Endocrine therapy
- Octreotide (Sandostatin) 0.5 mg SC TID
1-month cycle for up to 12 cycles
References
- 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 & Prednisone
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Regimen
Study | Evidence |
Loehrer et al. 2004 | Phase II |
Endocrine therapy, part 1
- Octreotide (Sandostatin) 0.5 mg SC TID
1-month cycle for 2 cycles
If stable disease after 2 cycles, patients would then receive:
Endocrine therapy, part 2
- Octreotide (Sandostatin) 0.5 mg SC TID
- Prednisone (Sterapred) 0.6 mg/kg PO once per day
1-month cycle for up to 10 additional cycles
References
- 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
Sunitinib monotherapy
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Regimen
Study | Evidence |
Thomas et al. 2015 | Phase II |
Chemotherapy
- Sunitinib (Sutent) 50 mg PO once per day on days 1 to 28
42-day cycles, given until progression of disease or unacceptable toxicity
References
- 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. contains verified protocol link to PMC article PubMed