Amrubicin, carboplatin duo efficacious in thymic carcinoma, not invasive thymoma

By Shreeya Nanda, Senior medwireNews Reporter

Combination therapy with amrubicin and carboplatin is moderately effective in patients with advanced thymic carcinoma, a Japanese study finds, but invasive thymoma patients do not benefit from this regimen.

Although platinum- and anthracycline-based regimens have been used to treat advanced thymic malignancies, the optimal chemotherapeutic regimens remain unclear, explain Akira Inoue (Tohoku University Hospital, Sendai) and study co-authors. They add that high-dose chemotherapy has been reported to be efficacious, but it has an adverse safety profile.

The researchers evaluated the efficacy of amrubicin 35 mg/m² given on days 1 and 3 of a 3-week cycle together with carboplatin at a dose of area under the curve 4.0 on day 1 in 51 patients with thymic malignancies. The amrubicin dose was reduced to 30 mg/m² in patients who had received chemotherapy previously.

The 33 thymic carcinoma patients had an objective response rate (ORR) of 30%, which increased to 42% when just the patients (n=19) who had not received chemotherapy previously were considered. The ORR was 17% for the 18 thymoma patients included in this phase II trial.

After a median follow-up of 24 months, median progression-free survival (PFS) was the same for both groups of patients, at 7.6 months. This compares favourably with the median PFS achieved with other regimens in thymic carcinoma patients, but is less than that achieved in previous invasive thymoma studies, say the researchers.

They add that this disparity in efficacy in the two disease states is “unsurprising” given that the conditions are different not only histologically, but also with respect to clinical features and genetic backgrounds.

The most frequently observed grade 3 or 4 adverse events were haematological in nature, with neutropenia, anaemia, febrile neutropenia and thrombocytopenia occurring in 82%, 33%, 22% and 20% of the study population, respectively. Grade 3 or 4 nonhaematological toxicities, such as nausea, diarrhoea and infection, were each observed in 4% of patients and there were no cases of cardiac toxicity.

Inoue et al conclude in the Journal of Thoracic Oncology that although the invasive thymoma findings are “disappointing”, the moderate efficacy of this regimen in patients with thymic carcinoma together with the “acceptable” toxicity warrants further investigation in this patient group.

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