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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: 1
  • Moderators:
  • Coordinates: 9/24/2018, 16:45 - 18:00, Exhibit Hall

  • 26655

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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): Carmen Giusy Rea
    • 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.

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