EGFR exon 20 insertion mutation in advanced thymic squamous cell carcinoma: Response to apatinib and clinical outcomes

Abstract

Thymic carcinoma (TC) is a rare malignant tumor of the mediastinum with occult onset, rapid development, and poor prognosis. Surgery is the main treatment for early TC, but the majority of patients are diagnosed at Masaoka‐Koga stage III or IV with local invasion or distant metastasis. Platinum and anthracyclines are currently considered key components of first‐line chemotherapy for advanced TC; however, there are no standard treatment plans for patients who are refractory to first‐line and further chemotherapy. The clinical effect is also unsatisfactory. Apatinib has been successfully applied as third‐line treatment for advanced gastric cancer and has shown high efficacy in the treatment of various cancers, such as lung, liver, and colorectal cancers. Herein we report a case of advanced thymic squamous cell carcinoma harboring EGFR exon 20 insertion in which apatinib was administered after multi‐line chemotherapy and radiotherapy and a partial response was achieved after five months of treatment. To date, a five month overall response and 10 months of progression‐free survival have been achieved. Adverse reactions can be controlled and the patient's quality of life has improved. Apatinib provides a new option for clinicians to treat patients with advanced TC.

Durable efficacy of anlotinib in a patient with advanced thymic squamous cell carcinoma after multiline chemotherapy and apatinib: A case report and literature review

“…This case was reported by our team in 2018, and his previous treatment is detailed in Yudong et al 6 . Here, we provide a detailed report on the patient's follow‐up treatment.…”

“…This case was reported by our team in 2018, and his previous treatment is detailed in Yudong et al 6 Here, we provide a detailed report on the patient's follow-up treatment. A 52-year-old Asian male with over 40-years history of smoking was diagnosed with Masaoka-Koga stage IVB thymic squamous cell carcinoma at a local hospital.…”

Complete remission following icotinib administration in an advanced ectopic thymic carcinoma patient harbouring the EGFR exon 19 deletion

“… 13 Advanced thymic squamous cell carcinoma patients with an EGFR exon 20 insertion mutation were reported to respond to apatinib, achieving a PFS of 10 months. 14 He et al 15 also reported that an advanced TC patient treated with apatinib after chemotherapy failure and multiple lung metastases achieved partial remission (PR) and PFS was 6.3 months. In a phase II study, 26 patients with advanced thymoma or TC were treated with gefitinib, with one patient achieving PR and 15 patients achieving stable disease; however, no patients achieved CR.…”

Emerging therapies in thymic epithelial tumors (Review)

“…Apatinib is a highly selective TKI, which mainly competes with the ATP-binding site of VEGFR-2. The patient was unable to tolerate the toxicity associated with apatinib and by the 13th month disease progressed ( 43 ). After the first anti-angiogenic TKI failed, anlotinib was well tolerated, without obvious AEs and the patient achieved a PFS of over 23 months; therefore, further clinical investigation of anlotinib is warranted ( 42 ).…”