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Pasqualina Perrone



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    P1.14 - Thymoma/Other Thoracic Malignancies (Not CME Accredited Session) (ID 946)

    • Event: WCLC 2018
    • Type: Poster Viewing in the Exhibit Hall
    • Track:
    • Presentations: 2
    • Moderators:
    • Coordinates: 9/24/2018, 16:45 - 18:00, Exhibit Hall
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      P1.14-06 - Treatment Outcomes of Patients with Thymic Carcinoma: A Monocentric Experience of Sequential Regimens Modality (ID 14222)

      16:45 - 18:00  |  Author(s): Pasqualina Perrone

      • Abstract
      • Slides

      Background

      Thymic carcinoma (TC) compared with thymoma has a lower incidence rate and is more likely to be diagnosed in advanced-stage disease, with a worst prognosis. Platinum combination regimen is widely recognized as the best treatment in the first line setting, followed by other systemic therapies, such as cytotoxic drugs and target agents, with the aim of achieving control disease and prolonging survival. Since there is limited information about the optimal treatment modality in TC, this study aims to identify the most promising therapeutic sequence in terms of efficacy and toxicity profile.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      We conducted a monocentric retrospective analysis of patients (pts) with un-resectable-metastatic TC, referred to our Rare Tumors Reference Center over a 15-year period. All pts with confirmed histological diagnosis, treated with at least three lines of therapy were included in the analysis. For each identified sequence treatment, progression free survival (PFS) and overall survival (OS), according to RECIST 1.1 and toxicity profile according to CTCAE v 4.0, were determined.

      4c3880bb027f159e801041b1021e88e8 Result

      Among 52 patients with advanced TC, 17 of them (32.6%) treated with at least three lines of chemotherapies and target agents (imatinib, sunitinib, everolimus) were included in the study. Three main therapeutic sequences were identified: 1) platinum-based therapy - platinum-based therapy – target agent (7 pts); 2) platinum-based therapy – capecitabine and gemcitabine combination-therapy – target agent (5 pts); 3) platinum- based therapy – target agent – no platinum-based chemo (5 pts). The median OS from the start of first-line chemotherapy was 67 months with no significant difference among sequences, with an OS respectively of 83, 67 and 106 months (p< 0.99). Also for PFS, with a median value of 33 months, there was registered no significant difference, with respectively 33, 38 and 32 months (p< 0.99). A different toxicity profile was instead revealed, with no adverse events more than grade 2 for the second and third sequence, and, conversely, toxicity of grade 3 registered in more than 50% of the pts in first sequence. Asthenia, emesis and pancytopenia which required hospitalization in 3 pts, were the most frequent.

      8eea62084ca7e541d918e823422bd82e Conclusion

      To our knowledge, this is the first data analysis of sequential regimens modality in patients with advanced TC. Since the efficacy of each treatment sequence did not vary significantly, we suggest to administer the therapy sequence with the better toxicity profile. Moreover, considering the median survival outcome reached, we support the need to refer these patients to reference center with high expertise.

      6f8b794f3246b0c1e1780bb4d4d5dc53

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      P1.14-18 - The Promising Role of Sunitinib Rechallenge in Heavily Pre-Treated Thymic Carcinoma: A Case Report (ID 14258)

      16:45 - 18:00  |  Author(s): Pasqualina Perrone

      • Abstract
      • Slides

      Background

      The clinical management of thymic carcinomas (TC), remains very challenging, however thanks to the optimization of therapeutic strategy, the 50% of patients is still alive at 5 years. The promising role of sunitinib, a multi tyrosine kinase inhibitor (TKI), has been recently confirmed in several prospective trials, but no data about the rechallenge modality administration are already available. In the case here reported, we illustrate an impressive response disease in a very heavily pre-treated TC after sunitinib rechallenge.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      In August 2013, a 45-year-old caucasian male was referred to our Institution, for a diagnosis of un-resectable/metastatic TC. A systemic therapy strategy was planned.

      4c3880bb027f159e801041b1021e88e8 Result

      Anthracycline-platinum-based chemotherapy was delivered as first, for total 6 cycles, obtained a partial response (PR) with more than 60% of disease reduction (DR). After a brief drug holiday, because of lung progression, the patient underwent capecitabine-gemcitabine combination-chemotherapy. In August 2014, he progressed after 6 cycles and was candidate to start sunitinib at standard dose of 50 mg daily/4 weeks on/2weeks off, in off-label modality. A dose reduction at 50 mg/daily/1 week on/1 week off was made due to persistent diarrhea G2, thrombocytopenia G2 and asthenia G3. Surprisingly, with no more toxicities, he achieved an important partial response with more than 70% of DR, maintained for total 26 months. Unfortunately, a new lung disease progression was registered and oral etoposide at dosage of 50 mg/die 3 weeks on/1 week off was started, without any results. Considering the great response obtained in the first line chemotherapy and envisioning the opportunity to revert target therapy resistance, as already demonstrated for other solid malignancies, 3 cycles of carboplatinum-paclitaxel were delivered, obtained stable disease. Analysis with NGS and microsatellities instability, were performed, with no results useful for the therapeutic decision process. In October 2017, because of the brilliant response achieved with sunitinib and considering the free interval of 12 months, a sunitinib rechallenge was established at 50 mg/daily 1 week on/1 week off. An impressive disease reduction, which is still ongoing, was revealed, no side effects were reported.

      8eea62084ca7e541d918e823422bd82e Conclusion

      This reported experience, shows sunitinib rechallenge effectiveness for prolonged control disease in thymic carcinoma, despite the number of previous treatments administered before the first and the second drug delivery. A personalized dose reduction can be used for treating heavily pre-treated thymic malignancies to better manage the toxicity profile. Rechallenge with TKI in previous responder patient, should be included routinely in the strategy for the treatment of refractory disease.

      6f8b794f3246b0c1e1780bb4d4d5dc53

      Only Active Members that have purchased this event or have registered via an access code will be able to view this content. To view this presentation, please login or select "Add to Cart" and proceed to checkout.