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Advances in Molecular Biology and Treatment of Thymic Epithelial Tumors

A special issue of International Journal of Molecular Sciences (ISSN 1422-0067). This special issue belongs to the section "Molecular Oncology".

Deadline for manuscript submissions: closed (20 September 2024) | Viewed by 6132

Special Issue Editor

Special Issue Information

Dear Colleagues,

Thymic epithelial tumors are considered the most common neoplasms of the thymus gland, representing, however, an extremely rare and heterogeneous type of tumor. They derive from the epithelial cells of the thymus gland and are broadly classified into thymomas and thymic carcinomas. On histological grounds, they are characterized by a combination of neoplastic epithelial cells and a non-neoplastic lymphoid component, admixed in various proportions.

The WHO classification further classifies thymic epithelial neoplasms based on the exact ratio differences in the epithelial and lymphocytic component, as well as the differentiation of epithelial cells towards the cortical or medullary epithelium. According to this nomenclature, there are six different subtypes, namely class A, AB, B1, B2, B3 and C. Type A tumors originate from the thymic medulla, type B from the thymic cortex, AB tumors are regarded as hybrids, while class C essentially refers to thymic carcinomas. The first four subtypes (A, AB, B1, B2) are considered as thymomas and show more benign biological properties. On the other hand, the B3 subtype represents an entity with intermediate biological characteristics, between the more benign thymomas and class C carcinomas.

The current first-line therapeutic approach for patients with early-stage thymic epithelial tumors is surgical resection. For patients with advanced-stage or incomplete resected tumors, there is a necessity for adjuvant therapy, currently consisting mostly of platinum-based chemotherapy. In this context, unraveling the molecular background of tumorigenesis in thymic epithelial neoplasms, allowing the identification of potential key targets for the development of new therapies, is of major importance.

This Special Issue aims to highlight the recent advances in molecular biology of this rare type of neoplasm in an effort to shed light on the biological mechanisms involved in the development and progression of thymic epithelial tumors, as well as to recognize potential novel targets of therapy.

For this purpose, we invite researchers to submit original research papers and high-quality comprehensive reviews to this Special Issue.

Dr. Georgia Levidou
Guest Editor

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Keywords

  • thymic epithelial tumors
  • thymomas
  • tumor biology
  • pathogenesis
  • carcinogenesis
  • biomarkers
  • tumor microenvironment
  • targeted therapy
  • predictive markers

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Published Papers (3 papers)

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Research

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14 pages, 1108 KiB  
Article
Comparative Analysis of Comprehensive Genomic Profile in Thymomas and Recurrent Thymomas Reveals Potentially Actionable Mutations for Target Therapies
by Filippo Lococo, Elisa De Paolis, Jessica Evangelista, Andrea Dell’Amore, Diana Giannarelli, Marco Chiappetta, Annalisa Campanella, Carolina Sassorossi, Alessandra Cancellieri, Fiorella Calabrese, Alessandra Conca, Emanuele Vita, Angelo Minucci, Emilio Bria, Angelo Castello, Andrea Urbani, Federico Rea, Stefano Margaritora and Giovanni Scambia
Int. J. Mol. Sci. 2024, 25(17), 9560; https://doi.org/10.3390/ijms25179560 - 3 Sep 2024
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Abstract
Molecular profiles of thymomas and recurrent thymomas are far from being defined. Herein, we report an analysis of a comprehensive genetic profile (CGP) in a highly selected cohort of recurrent thymomas. Among a cohort of 426 thymomas, the tissue was available in 23 [...] Read more.
Molecular profiles of thymomas and recurrent thymomas are far from being defined. Herein, we report an analysis of a comprehensive genetic profile (CGP) in a highly selected cohort of recurrent thymomas. Among a cohort of 426 thymomas, the tissue was available in 23 recurrent tumors for matching the biomolecular results obtained from primary and relapse samples. A control group composed of non-recurrent thymoma patients was selected through a propensity score match analysis. CGP was performed using the NGS Tru-SightOncology assay to evaluate TMB, MSI, and molecular alterations in 523 genes. CGP does not differ when comparing initial tumor with tumor relapse. A significantly higher frequency of cell cycle control genes alterations (100.0% vs. 57.1%, p = 0.022) is detected in patients with early recurrence (<32 months) compared to late recurrent cases. The CGPs were similar in recurrent thymomas and non-recurrent thymomas. Finally, based on NGS results, an off-label treatment or clinical trial could be potentially proposed in >50% of cases (oncogenic Tier-IIC variants). In conclusion, CGPs do not substantially differ between initial tumor vs. tumor recurrence and recurrent thymomas vs. non-recurrent thymomas. Cell cycle control gene alterations are associated with an early recurrence after thymectomy. Multiple target therapies are potentially available by performing a comprehensive CGP, suggesting that a precision medicine approach on these patients could be further explored. Full article
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14 pages, 3158 KiB  
Communication
Histone Deacetylases (HDACs): Promising Biomarkers and Potential Therapeutic Targets in Thymic Epithelial Tumors
by Kostas Palamaris, Luisa-Maria Tzimou, Georgia Levidou, Christos Masaoutis, Irene Theochari, Dimitra Rontogianni and Stamatios Theocharis
Int. J. Mol. Sci. 2023, 24(5), 4263; https://doi.org/10.3390/ijms24054263 - 21 Feb 2023
Cited by 4 | Viewed by 2370
Abstract
Histone deacetylases (HDACs) are core epigenetic factors, with pivotal roles in the regulation of various cellular procedures, and their deregulation is a major trait in the acquisition of malignancy properties. In this study we attempt the first comprehensive evaluation of six class I [...] Read more.
Histone deacetylases (HDACs) are core epigenetic factors, with pivotal roles in the regulation of various cellular procedures, and their deregulation is a major trait in the acquisition of malignancy properties. In this study we attempt the first comprehensive evaluation of six class I (HDAC1, HDAC2, HDAC3) and II HDACs (HDAC4, HDAC5, HDAC6) expression patterns in thymic epithelial tumors (TETs), with the aim of identifying their possible association with a number of clinicopathological parameters. Our study revealed higher positivity rates and expression levels of class I enzymes compared to class II. Sub-cellular localization and level of staining varied among the six isoforms. HDAC1 was almost exclusively restricted to the nucleus, while HDAC3 demonstrated both nuclear and cytoplasmic reactivity in the majority of examined specimens. HDAC2 expression was higher in more advanced Masaoka–Koga stages, and displayed a positive correlation with dismal prognoses. The three class II HDACs (HDAC4, HDAC5, HDAC6) exhibited similar expression patterns, with predominantly cytoplasmic staining, that was higher in epithelial rich TETs (B3, C) and more advanced tumor stages, while it was also associated with disease recurrence. Our findings could provide useful insights for the effective implementation of HDACs as biomarkers and therapeutic targets for TETs, in the setting of precision medicine. Full article
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Review

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15 pages, 321 KiB  
Review
An Overview of the Use of Anti-Angiogenic Agents in the Treatment of Thymic Epithelial Tumors
by Apostolos C. Agrafiotis, Lawek Berzenji, Stien Koyen, Dries Vermeulen, Rachel Winthagen, Jeroen M. H. Hendriks and Paul E. Van Schil
Int. J. Mol. Sci. 2023, 24(23), 17065; https://doi.org/10.3390/ijms242317065 - 2 Dec 2023
Cited by 1 | Viewed by 1803
Abstract
Angiogenesis significantly influences the carcinogenesis of thymic epithelial tumors (TET). Both thymomas and thymic carcinoma (TC) overexpress VEGF-A and VEGFR-1 and -2. This review aims to provide an appraisal of the use of anti-angiogenics in the treatment of TET. The literature research identified [...] Read more.
Angiogenesis significantly influences the carcinogenesis of thymic epithelial tumors (TET). Both thymomas and thymic carcinoma (TC) overexpress VEGF-A and VEGFR-1 and -2. This review aims to provide an appraisal of the use of anti-angiogenics in the treatment of TET. The literature research identified 16 studies that were deemed eligible for further analysis. Seven studies assessed the clinical efficacy of sunitinib and five studies the use of apatinib and/or anlotinib. The multicenter Japanese phase II REMORA trial investigated the efficacy of lenvatinib, which is a multi-targeted inhibitor of VEGFR, FGFR, RET, c-Kit, and other kinases. The objective response rate was 38% (25.6–52%), which is the highest documented in TET that progressed after first-line chemotherapy. Anti-angiogenic agents may be useful in the treatment of TET, which are not amenable to curative treatment. Their toxicity profile seems to be acceptable. However, angiogenesis inhibitors do not appear to have a major influence on either thymomas or TC, although multikinase inhibitors may have some effect on TC. The current evidence suggests that the most active agent is lenvatinib, whereas sunitinib could be proposed as an acceptable second-line therapy for TC. Further research concerning the combination of immune checkpoint inhibitors with anti-angiogenic drugs is warranted. Full article
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