-
Journal of Cancer Research and Clinical... Feb 2015Thymic malignancies, comprising thymoma and thymic carcinoma, are rare. Consequently, optimal chemotherapy for advanced thymic malignancies remains controversial.... (Review)
Review
PURPOSE
Thymic malignancies, comprising thymoma and thymic carcinoma, are rare. Consequently, optimal chemotherapy for advanced thymic malignancies remains controversial. Platinum-based chemotherapy is currently the consensus treatment based on the results of single-arm phase II trials and retrospective investigations. However, comparison of cisplatin-based and carboplatin-based chemotherapy has yet to be undertaken; the effectiveness of the addition of anthracycline also remains uncertain.
METHODS
In the present study, clinical trials and retrospective data regarding platinum-based chemotherapy were analyzed. The endpoint was the response rate to each chemotherapy. For advanced thymoma, we compared platinum with anthracycline-based chemotherapy and platinum with non-anthracycline-based chemotherapy. For advanced thymic carcinoma, anthracycline-based versus non-anthracycline-based chemotherapy and carboplatin-based versus cisplatin-based chemotherapy were compared. This analysis included a retrospective study of response of advanced thymic carcinoma to irinotecan and cisplatin in our institution.
RESULTS
The response rate for the 314 patients from 15 studies with advanced thymoma, including both prospective and retrospective data, was 69.4% [95% confidence interval (CI) 63.1-75.0%] for platinum with anthracycline-based chemotherapy and 37.8% (95% CI 28.1-48.6%; p < 0.0001) for platinum with non-anthracycline-based chemotherapy. The response rates after anthracycline-based and non-anthracycline-based chemotherapy for advanced thymic carcinoma were similar (41.8 vs. 40.9%; p < 0.91), whereas the response rates after cisplatin-based and carboplatin-based chemotherapy for advanced thymic carcinoma differed significantly (53.6 vs. 32.8%; p = 0.0029) in 206 patients from 10 studies.
CONCLUSIONS
Platinum with anthracycline-based chemotherapy is an optimal combination for advanced thymoma. For advanced thymic carcinoma, cisplatin-based chemotherapy may be superior to carboplatin-based chemotherapy.
Topics: Anthracyclines; Antineoplastic Combined Chemotherapy Protocols; Carboplatin; Cisplatin; Clinical Trials as Topic; Humans; Prognosis; Thymus Neoplasms
PubMed: 25146529
DOI: 10.1007/s00432-014-1800-6 -
European Journal of Cardio-thoracic... Jul 2015Thymectomy has become an increasingly popular procedure for myasthenia gravis. Knowledge of factors associated with a good outcome (remission) or those most likely to... (Review)
Review
Thymectomy has become an increasingly popular procedure for myasthenia gravis. Knowledge of factors associated with a good outcome (remission) or those most likely to benefit from surgery can help clinical decision-making. A systematic review search was conducted in Medline and Embase for English language studies from 1985 through to February 2014. Studies which evaluated variables associated with, or predictive of, remission in adult (≥18 years) myasthenic patients after thymectomy and using multivariable regression models were included. Statistical pooling was not appropriate due to methodological heterogeneity. From 128 potentially relevant studies, 18 reports of 19 studies met the inclusion criteria. Preoperative mild disease classification (i.e. studies reported this variable as Osserman classification 1, 2A or MGFA I-II) showed the most consistent association with remission. Evidence for several other prognostic factors was inconclusive, or no evidence was found. Gender, age and absence of thymoma (or hyperplasia) were not associated with remission following thymectomy. Patients with mild disease preoperatively may have a better chance of remission of MG after thymectomy.
Topics: Adult; Humans; Myasthenia Gravis; Prognosis; Remission Induction; Thymectomy; Treatment Outcome
PubMed: 25108896
DOI: 10.1093/ejcts/ezu309