The efficacy of tacrolimus and sirolimus in heavily pre-treated unresectable thymic malignancies

• Published in: Lung cancer (Amsterdam, Netherlands) Netherlands), 2013-05, Vol.80 (2), p.228-229
• Main Authors: Payne, S.J.L, Krell, J, Wilson, P, Ansell, W, Frampton, A.E, Stebbing, J, Shamash, J
• Format: Article
• Language: English
• Subjects: Aged; Biological and medical sciences; Combined Modality Therapy; Drug-Related Side Effects and Adverse Reactions - chemically induced; Drug-Related Side Effects and Adverse Reactions - pathology; Female; Hematology, Oncology and Palliative Medicine; Humans; Immunosuppressants; Immunosuppressive Agents - administration & dosage; Male; Medical sciences; Middle Aged; Multiple tumors. Solid tumors. Tumors in childhood (general aspects); Neoplasm Recurrence, Local - drug therapy; Pneumology; Pulmonary/Respiratory; Sirolimus; Sirolimus - administration & dosage; Sirolimus - adverse effects; Tacrolimus; Tacrolimus - administration & dosage; Tacrolimus - adverse effects; Thymectomy; Thymic tumours; Thymomas; Thymus Neoplasms - drug therapy; Thymus Neoplasms - pathology; Thymus Neoplasms - surgery; Tumors; Tumors of the respiratory system and mediastinum
• ISSN: 0169-5002; 1872-8332
• DOI: 10.1016/j.lungcan.2012.12.020

Abstract Background Thymomas and thymic carcinomas, although uncommon, constitute a significant proportion of anterior mediastinal tumours. Systemic chemotherapy is the mainstay of treatment for inoperable or recurrent disease, but immunosuppressive therapy may provide an alternative treatment strategy. Patients and methods We present a series of 18 patients diagnosed with unresectable thymic tumours, of which eight received immunosuppressive therapy following relapse after chemotherapy. Results Eight individuals were treated with primary immunotherapy after a median of 3.5 lines of chemotherapy (range 2–6 lines), of which 3 had confirmed myasthenia gravis (MG). After 3 months, 2 patients achieved a radiological partial response and 4 had stable disease. The median time to progression measured 6.8 months (CI 1.4–19.3 months). Two of the 4 patients who progressed on tacrolimus and prednisolone received sirolimus. One of these patients has stable disease (SD) at 21 months, and the other has SD at 3 months. Conclusions Although previous case reports have related tacrolimus therapy with tumour shrinkage in patients with MG-associated invasive thymomas, these data are the first to demonstrate the efficacy of such immunosuppressive agents in a larger cohort of heavily pre-treated patients with thymic tumours. Our experience adds to the limited anecdotal evidence in the literature, and suggests that immunosuppressive agents represent a valuable additional treatment for thymic tumours.