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Cancers
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Thymic Carcinoma
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Thymic Carcinoma

A special issue of Cancers (ISSN 2072-6694). This special issue belongs to the section "Cancer Therapy".

Deadline for manuscript submissions: closed (28 November 2021) | Viewed by 12104

Special Issue Editor

Dr. Kyoichi Kaira

E-Mail Website
Guest Editor
Department of Respiratory Medicine, Comprehensive Cancer Center, International Medical Center, Saitama University Hospital, 1397-1 Yamane, Hidaka-City, Saitama 350-1298, Japan
Interests: thymic cancer; surgery; chemotherapy; radiotherapy; PET; pathology; prognostic factor

Special Issue Information

Dear Colleagues,

Thymic epithelial tumors, which are generally classified as thymomas and thymic carcinomas, are uncommon neoplasms presenting in less than 2.0% of all malignancies. In particular, thymic carcinoma is a rare neoplasm with a dismal outcome and no available therapeutic agents for its advanced form. Therefore, the identification of new targets that can serve as predictive and prognostic markers for the development of an optimal treatment plan is essential. To treat thymic cancer, surgery, radiotherapy and chemotherapy are chosen according to its expansion. Surgical resection is absolutely suitable for early disease, but it is hard to cure the patients with advanced disease by systemic chemotherapy or radiotherapy. Meanwhile, it is of critical importance to develop predictive biomarkers (e.g., PET as an indicator of metabolic activity) and different kinds of pathologic markers. Molecular imaging techniques have been under recent development in oncology. An optimal approach realizes the improvement of curative treatment of thymic carcinoma. The scope of this Special Issue includes the therapeutic significance of new modalities, molecular imaging and optimal biomarkers.

Prof. Dr. Kyoichi Kaira
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Cancers is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2900 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • thymic cancer
  • surgery
  • chemotherapy
  • radiotherapy
  • PET
  • pathology
  • prognostic factor

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Published Papers (5 papers)

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Research

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14 pages, 1580 KiB  
Article
Clinical Significance of Tumor Markers for Advanced Thymic Carcinoma: A Retrospective Analysis from the NEJ023 Study
by Tomoyasu Mimori, Takehito Shukuya, Ryo Ko, Yusuke Okuma, Tomonobu Koizumi, Hisao Imai, Yuichi Takiguchi, Eisaku Miyauchi, Hiroshi Kagamu, Tomohide Sugiyama, Keisuke Azuma, Yukiko Namba, Masahiro Yamasaki, Hisashi Tanaka, Yuta Takashima, Sayo Soda, Osamu Ishimoto, Nobuyuki Koyama, Kunihiko Kobayashi and Kazuhisa Takahashi
Cancers 2022, 14(2), 331; https://doi.org/10.3390/cancers14020331 - 11 Jan 2022
Cited by 4 | Viewed by 2624
Abstract
The optimal tumor marker for predicting the prognosis of advanced thymic carcinoma (ATC) remains unclear. We conducted a multi-institutional retrospective study of patients with ATC. A total of 286 patients were treated with chemotherapy. Clinicopathological information, including serum tumor markers, was evaluated to [...] Read more.
The optimal tumor marker for predicting the prognosis of advanced thymic carcinoma (ATC) remains unclear. We conducted a multi-institutional retrospective study of patients with ATC. A total of 286 patients were treated with chemotherapy. Clinicopathological information, including serum tumor markers, was evaluated to determine the overall survival (OS) and progression-free survival (PFS). The carcinoembryonic antigen, cytokeratin-19 fragment, squamous cell carcinoma (SCC) antigen, progastrin-releasing peptide, neuron-specific enolase (NSE), and alpha-fetoprotein levels were evaluated. In the Kaplan–Meier analysis, the OS was significantly shorter in the patients with elevated NSE levels than in those with normal NSE levels (median, 20.3 vs. 36.8 months; log-rank test p = 0.029; hazard ratio (HR), 1.55; 95% confidence interval (CI), 1.05–2.31 (Cox proportional hazard model)); a similar tendency regarding the PFS was observed (median, 6.4 vs. 11.0 months; log-rank test p = 0.001; HR, 2.04; 95% CI, 1.31–3.18). No significant differences in the OS and PFS were observed among the other tumor markers. In both univariate and multivariate analyses of the patients with SCC only, the NSE level was associated with the OS and PFS. Thus, the NSE level may be a prognostic tumor marker for thymic carcinoma, regardless of histology. Full article
(This article belongs to the Special Issue Thymic Carcinoma)
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11 pages, 281 KiB  
Article
Estimated Risk of Radiation-Induced Cancer after Thymoma Treatments with Proton- or X-ray Beams
by Anders Lideståhl, Gracinda Johansson, Albert Siegbahn and Pehr A. Lind
Cancers 2021, 13(20), 5153; https://doi.org/10.3390/cancers13205153 - 14 Oct 2021
Cited by 5 | Viewed by 1750
Abstract
We compared the calculated risks of radiation-induced secondary malignant neoplasms (SMNs) for patients treated for thymic tumors with 3D-CRT, IMRT, or single-field uniform dose (SFUD) proton beam therapy (PBT) using the pencil beam scanning (PBS) technique. A cancer-induction model based on the organ [...] Read more.
We compared the calculated risks of radiation-induced secondary malignant neoplasms (SMNs) for patients treated for thymic tumors with 3D-CRT, IMRT, or single-field uniform dose (SFUD) proton beam therapy (PBT) using the pencil beam scanning (PBS) technique. A cancer-induction model based on the organ equivalent dose (OED) concept was used. For twelve patients, treated with 3D-CRT for thymic tumors, alternative IMRT and SFUD plans were retrospectively prepared. The resulting DVHs for organs at risk (OARs) were extracted and used to estimate the risk of SMNs. The OED was calculated using a mechanistic model for carcinoma induction. Two limit cases were considered; the linear-exponential model, in which the repopulation/repair of the cells is neglected, and the plateau model, in which full repopulation/repair of the irradiated cells is assumed. The calculated risks for SMNs for the different radiation modalities and dose-relation models were used to calculate relative risks, which were compared pairwise. The risks for developing SMNs were reduced for all OARs, and for both dose-relation models, if SFUD was used, compared to 3D-CRT and IMRT. In conclusion, PBS shows a potential benefit to reduce the risk of SMNs compared to 3D-CRT and IMRT in the treatment of thymic tumors. Full article
(This article belongs to the Special Issue Thymic Carcinoma)

Review

Jump to: Research

13 pages, 276 KiB  
Review
Salvage Chemotherapy in Patients with Previously Treated Thymic Carcinoma
by Kyoichi Kaira, Hisao Imai, Ou Yamaguchi, Atsuto Mouri and Hiroshi Kagamu
Cancers 2021, 13(21), 5441; https://doi.org/10.3390/cancers13215441 - 29 Oct 2021
Cited by 4 | Viewed by 2200
Abstract
Thymic carcinoma is a rare neoplasm, and it is difficult to achieve complete remission with systemic chemotherapy. In advanced or recurrent thymic carcinoma, platinum-based chemotherapy is chosen as the first-line setting; however, it remains unclear which regimen is better to improve its outcome. [...] Read more.
Thymic carcinoma is a rare neoplasm, and it is difficult to achieve complete remission with systemic chemotherapy. In advanced or recurrent thymic carcinoma, platinum-based chemotherapy is chosen as the first-line setting; however, it remains unclear which regimen is better to improve its outcome. It remains unknown whether salvage chemotherapy should be administered to patients with platinum-based chemotherapy-refractory thymic carcinoma. Currently, several clinical studies have investigated the efficacy of second-line settings for advanced thymic carcinoma. As cytotoxic agents, S-1, amrubicin, pemetrexed, docetaxel, paclitaxel, and gemcitabine have been reported as prospective phase II studies or retrospective studies. The overall response rates (ORRs) of S-1, amrubicin, and pemetrexed were 25–50%, 11–44.4%, and 9–10%, respectively. Molecular targeting drugs, such as sunitinib, everolimus, and lenvatinib, also provide clinical effectiveness with tolerability after the failure of platinum-based regimens. Based on the results of the prospective phase II study, the ORR, median progression-free survival, and median overall survival were 16.6% and 5.6 months, respectively, in everolimus, 26% and 7.2 months, respectively, in sunitinib, and 38% and 9.3 months, respectively, in lenvatinib. Although it is difficult to compare each study, lenvatinib appears to be better in increasing efficacy as a second-line setting. However, each study had a small sample size, which may have biased the results of their studies. Further investigation is warranted to elucidate the therapeutic significance of salvage chemotherapy in advanced thymic carcinoma in a large-scale study. Full article
(This article belongs to the Special Issue Thymic Carcinoma)
13 pages, 321 KiB  
Review
Future Perspective of Chemotherapy and Pharmacotherapy in Thymic Carcinoma
by Rui Kitadai and Yusuke Okuma
Cancers 2021, 13(20), 5239; https://doi.org/10.3390/cancers13205239 - 19 Oct 2021
Cited by 4 | Viewed by 2688
Abstract
Thymic carcinoma is a rare cancer that arises from thymic epithelial cells. Its nature and pathology differ from that of benign thymoma, presenting a poorer prognosis. If surgically resectable, surgery alone or surgery followed by chemoradiotherapy or radiotherapy is recommended by the National [...] Read more.
Thymic carcinoma is a rare cancer that arises from thymic epithelial cells. Its nature and pathology differ from that of benign thymoma, presenting a poorer prognosis. If surgically resectable, surgery alone or surgery followed by chemoradiotherapy or radiotherapy is recommended by the National Comprehensive Cancer Network Guidelines. Metastatic and refractory thymic carcinomas require systemic pharmacotherapy. Combined carboplatin and paclitaxel, and cisplatin and anthracycline-based regimens have been shown a fair response rate and survival to provide a de facto standard of care when compared with other drugs employed as first-line chemotherapy. Cytotoxic agents have been pivotal for treating thymic carcinoma, as little is known regarding its tumorigenesis. In addition, genetic alterations, including driver mutations, which play an important role in treatments, have not yet been discovered. However, molecular pathways and biomarker studies assessing thymic epithelial tumors have been reported recently, resulting in the development of new agents, such as molecular targeted agents and immune checkpoint inhibitors. As treatment options are currently limited and the prognosis remains poor in metastases and recurrent thymic carcinoma, genetic alterations need to be assessed. In the present review, we focused on the current role of targeted therapies and immune checkpoint inhibitors in treating thymic carcinoma. Full article
(This article belongs to the Special Issue Thymic Carcinoma)
10 pages, 249 KiB  
Review
Perspective of Immune Checkpoint Inhibitors in Thymic Carcinoma
by Kyoichi Kaira, Hisao Imai and Hiroshi Kagamu
Cancers 2021, 13(5), 1065; https://doi.org/10.3390/cancers13051065 - 3 Mar 2021
Cited by 8 | Viewed by 2068
Abstract
Thymic carcinoma is a rare neoplasm with a dismal prognosis, and there are no established therapeutic regimens for metastatic or recurrent disease. Immune checkpoint inhibitors (ICIs), such as PD-1/PD-L1 antibodies, are widely approved in several human cancers, contributing to prolonging survival in thoracic [...] Read more.
Thymic carcinoma is a rare neoplasm with a dismal prognosis, and there are no established therapeutic regimens for metastatic or recurrent disease. Immune checkpoint inhibitors (ICIs), such as PD-1/PD-L1 antibodies, are widely approved in several human cancers, contributing to prolonging survival in thoracic tumors. Thymic carcinoma exhibits histologic properties of squamous cell carcinoma (SQC), and resembles the SQC of the lung. ICIs are not approved in thymic carcinoma. Thus, several clinical trials have been undertaken to demonstrate if they are therapeutically effective for patients with thymic carcinoma. In our review, three prospective phase II studies and several case series were discussed in thymic carcinoma. We found that the objective response rate, disease control rate, and progression-free survival in PD-1 blockade monotherapy were approximately 20%, 73%, and four months, respectively. Two exploratory investigations indicated that PD-L1 within tumor cells exhibits a possibility of the therapeutic prediction of PD-1 blockade in thymic carcinoma. Several case reports, alongside their treatment content, have also been reviewed. The therapeutic efficacy of PD-1 blockade monotherapy is still limited in patients with thymic carcinoma. Future perspectives focus on the therapeutic implication of tyrokinase inhibitors plus ICIs or new experimental agents plus ICIs alongside several ongoing experimental studies. Full article
(This article belongs to the Special Issue Thymic Carcinoma)
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