Systemic treatments for thymic tumors: a narrative review

Abstract

Thymic epithelial tumours (TETs) are rare tumours originating from the thymus. Considering the rarity of this disease, the management of TETs is still challenging and difficult. In fact, all the worldwide clinical practice guidelines are based on data from retrospective analyses, prospective single arm trials or experts’ opinions. The results of combined modality therapy (chemotherapy, surgery, radiotherapy) in thymic malignancies are reasonably good in less advanced cases whereas in case of advanced (unsuitable for surgery) or metastatic disease, a platinum-based chemotherapy is considered standard of care. Unfortunately, chemotherapy in the palliative setting has modest efficacy. Moreover, due to the lack of known oncogenic molecular alterations, no targeted therapy has been shown to be efficient for these tumours. In order to offer the best diagnostic and therapeutic tools, patients with TETs should be managed with a continuous and specific multidisciplinary expertise at any step of the disease, especially in the era of a novel coronavirus disease (COVID-19). Current evidences show that cancer patients might have more severe symptoms and poorer outcomes from COVID-19 infection than general population. With the exception of the patients carrying a Good’s syndrome, there is no evidence that patients with TETs present a higher risk of infection compared with other cancer patients and their management should be the same. The aim of this review is to summarize the existing literature about systemic treatments for TETs in all clinical setting (local and locally advanced/metastatic disease) exploring how these therapeutic strategies have been managed in the COVID-19 era.

Spleen metastasis of recurrent malignant thymoma

“…According to the guidelines of the National Comprehensive Cancer Network [ 7 ] (revised in 2014), complete tumour removal is recommended for resectable thymomas. In addition, radiation therapy, chemotherapy and/or postoperative adjuvant therapy may be appropriate depending on the stage.…”

Radical Removal of Low-Differentiation Thymic Squamous Cell Carcinoma: A Rare Clinical Case

“…This type of pathology occurs relatively infrequently in the population and affects men and women at the same percentage ratio. After a clinical consultation, our team opted for surgical treatment using the Da Vinci robotic system, which offers the advantages of reduced trauma, lower intraoperative and postoperative bleeding, and a shorter recovery period for the patient [ 5 ]. During the surgical intervention, due to the established infiltration of the anonymous vein and the upper lobe of the left lung, a median sternotomy was performed to better expose the structures, control the large vessels, and achieve radical removal of the tumor [ 6 ].…”

Rare thoracic cancers: a comprehensive overview of diagnosis and management of small cell lung cancer, malignant pleural mesothelioma and thymic epithelial tumours

“…However, chemotherapy could be also considered as adjuvant therapy in stage II, III and IVA radically resected thymic carcinoma, and in all TETs after R2 resection. Moreover, some experts suggest also discussing adjuvant chemotherapy in R1 resected B3 thymomas [ 121 ].…”