Current Treatment Approaches for Thymic Epithelial Tumors

Tartarone, Alfredo; Lerose, Rosa; Lettini, Alessandro Rocco; Tartarone, Marina

doi:10.3390/life13051170

Cited by 3 publications

(3 citation statements)

References 45 publications

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“…Recently, ICI therapy has been used for thymic epithelial tumors, and although there are some reports indicating that ICI is effective, the incidence of immune-related adverse events is high ( 3 ).…”

Section: Methodsmentioning

confidence: 99%

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Perspectives on surgical treatment for thymic epithelial tumors: a narrative review

Nabe,

Inoue,

Yoshida

2024

Gland Surg

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Background and Objective Thymic epithelial tumors are relatively rare; thus, mostly retrospective studies and a few prospective randomized controlled trials have been conducted on the treatment and the biomarkers, with no standard therapy established. Indications for extended thymectomy, robot-assisted thoracic surgery, and multidisciplinary treatment are controversial. Here, we considered the prospects of surgical treatment and the possibility of immune checkpoint inhibitor (ICI) treatment for thymic epithelial tumors. Methods This is a narrative review; PubMed was searched using a set of keywords related to thymoma and its proposed treatments over the last 5 years. Key Content and Findings Thymic epithelial tumors are associated with autoimmune diseases. They are relatively rare, and their pathology remains unclear. Therefore, accumulating more case reports is important. Surgical resection is generally considered for both diagnosis and treatment. If the tumor has a strong tendency to invade surrounding areas, such as thymic carcinoma/thymoma, the diagnosis may be confirmed preoperatively by needle biopsy, and induction chemotherapy may be selected. Surgical resection is the most effective treatment, and complete resection is important. In cases where complete resection is difficult, multidisciplinary treatment is performed. Although there are various obstacles, using ICIs may prove effective for treatment both as preoperative and postoperative chemotherapy in the future, as shown for other cancers. Programmed cell death-ligand 1 (PD-L1) is an immunoinhibitory molecule that suppresses T cells activation, leading to tumor progression. Overexpression of PD-L1 in some cancers is associated with poor clinical outcomes. However, the role of PD-L1 expression as a prognostic factor remains controversial. Therefore, various biomarkers other than PD-L1 have been identified. Conclusions We reviewed the latest treatments for thymic epithelial tumors. If new therapeutic agents such as ICIs and molecular-targeted drugs are developed, this review suggests that surgery will become more important not only as therapy but also as part of multidisciplinary treatment that includes tissue collection.

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Section: Methodsmentioning

confidence: 99%

“…Thymic epithelial tumors are uncommon tumors that originate from the epithelial cells of the thymus, and the relatively rare diseases mainly occur in the anterior mediastinum and undergo malignant progression owing to recurrence and distant metastasis ( 1 - 3 ). These tumors include thymoma, thymic carcinoma, and neuroendocrine tumors.…”

Section: Introductionmentioning

confidence: 99%

Perspectives on surgical treatment for thymic epithelial tumors: a narrative review

Nabe,

Inoue,

Yoshida

2024

Gland Surg

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“…Category 2 includes patients with unresectable TETs, lymphomas, Castleman disease, or malignant germ cell tumors, who are recommended to start with CNB [15][16][17]. After a confirmed pathologic diagnosis, Category 2 patients may receive targeted therapy, chemotherapy, and/or radiotherapy [18,19].…”

Section: Introductionmentioning

confidence: 99%

Therapeutic Decision Making in Prevascular Mediastinal Tumors Using CT Radiomics and Clinical Features: Upfront Surgery or Pretreatment Needle Biopsy?

Chang,

Lin,

Liu

et al. 2024

Cancers

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The study aimed to develop machine learning (ML) classification models for differentiating patients who needed direct surgery from patients who needed core needle biopsy among patients with prevascular mediastinal tumor (PMT). Patients with PMT who received a contrast-enhanced computed tomography (CECT) scan and initial management for PMT between January 2010 and December 2020 were included in this retrospective study. Fourteen ML algorithms were used to construct candidate classification models via the voting ensemble approach, based on preoperative clinical data and radiomic features extracted from the CECT. The classification accuracy of clinical diagnosis was 86.1%. The first ensemble learning model was built by randomly choosing seven ML models from a set of fourteen ML models and had a classification accuracy of 88.0% (95% CI = 85.8 to 90.3%). The second ensemble learning model was the combination of five ML models, including NeuralNetFastAI, NeuralNetTorch, RandomForest with Entropy, RandomForest with Gini, and XGBoost, and had a classification accuracy of 90.4% (95% CI = 87.9 to 93.0%), which significantly outperformed clinical diagnosis (p < 0.05). Due to the superior performance, the voting ensemble learning clinical–radiomic classification model may be used as a clinical decision support system to facilitate the selection of the initial management of PMT.

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Immunotherapy in thymic epithelial tumors: tissue predictive biomarkers for immune checkpoint inhibitors

Lucà,

Accardo,

Campione

et al. 2024

Exploration of Targeted Anti-Tumor Therapy

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Thymic epithelial tumors (TETs) are rare malignant neoplasms arising in the thymus gland. Nevertheless, TETs, including thymomas (TMs), thymic carcinomas (TCs), and thymic neuroendocrine neoplasms (TNENs), are the most common mediastinal malignancies overall. A multidisciplinary approach is required for the appropriate diagnostic and therapeutic management of TETs. To date, the main therapeutic strategies are largely depended on the stage of the tumor and they include surgery with or without neoadjuvant or adjuvant therapy, represented by platinum-based chemotherapy, radiotherapy or chemoradiotherapy. Immune checkpoint inhibitors (ICIs) are ongoing under evaluation in the advanced or metastatic diseases despite the challenges related to the very low tumor mutation burden (TMB) and the high incidence of immune-related adverse events in TETs. In this regard, predictive impact of tissue biomarkers expression such as programmed cell death ligand-1 (PD-L1), and other emerging biomarkers, as well as their optimal and shared interpretation are currently under evaluation in order to predict response rates to ICIs in TETs.

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Current Treatment Approaches for Thymic Epithelial Tumors

Cited by 3 publications

References 45 publications

Perspectives on surgical treatment for thymic epithelial tumors: a narrative review

Perspectives on surgical treatment for thymic epithelial tumors: a narrative review

Therapeutic Decision Making in Prevascular Mediastinal Tumors Using CT Radiomics and Clinical Features: Upfront Surgery or Pretreatment Needle Biopsy?

Immunotherapy in thymic epithelial tumors: tissue predictive biomarkers for immune checkpoint inhibitors

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