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Immunotherapy for thymoma.

Marko Jakopovic1,2, Lela Bitar2, Fran Seiwerth2

  • 1School of Medicine, University of Zagreb, Zagreb, Croatia.

Journal of Thoracic Disease
|January 15, 2021
PubMed
Summary

Immune checkpoint inhibitors show promise for thymic epithelial tumors (TETs), despite rare occurrence. Early trials indicate effectiveness, but further research is needed to confirm safety and optimal use for these rare cancers.

Keywords:
Thymic epithelial tumor (TET)immune checkpoint inhibitors (ICIs)immune-related adverse eventsthymic cancerthymoma

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Area of Science:

  • Oncology
  • Immunotherapy
  • Thoracic Surgery

Background:

  • Thymic epithelial tumors (TETs) are rare neoplasms and the most common anterior mediastinal tumors in adults.
  • Limited efficacy of current treatments necessitates novel therapeutic strategies for TETs.
  • High PD-L1 expression and CD8+ lymphocytes in TETs support the rationale for immune checkpoint inhibitor (ICI) therapy.

Purpose of the Study:

  • To evaluate the efficacy and safety of immune checkpoint inhibitors (ICIs) targeting the PD-1/PD-L1 pathway in thymic epithelial tumors.
  • To assess the response rates and progression-free survival in patients with thymoma and thymic carcinoma treated with ICIs.
  • To identify predictors of response to ICIs in TETs.

Main Methods:

  • Review of early-stage clinical trials evaluating pembrolizumab and avelumab in thymoma and thymic carcinoma patients.
  • Analysis of response rates, progression-free survival, and immune-related adverse events.
  • Correlation of PD-L1 expression levels with treatment response.

Main Results:

  • Early trials demonstrated reasonable response rates and progression-free survival with ICIs in TET patients.
  • Higher PD-L1 expression was consistently associated with a better treatment response.
  • An increased incidence of immune-related adverse events was observed in TET patients compared to other cancer types.

Conclusions:

  • ICIs represent an attractive therapeutic option for thymic epithelial tumors, showing promising efficacy.
  • PD-L1 expression is a potential predictive biomarker for ICI response in TETs.
  • Larger clinical trials are required to establish the definitive role of ICIs in TET treatment, balancing efficacy and safety.