Chemotherapy (drug treatment) for inoperable thymic cancer in adults

Question: Which type and when should chemotherapy (drug treatment) be given to people with thymic carcinoma or advanced thymoma?

Background: Thymic cancers are rare tumours arising in the thymus gland behind the breastbone in the chest cavity. For people with advanced-stage thymic tumours complete surgical resection is normally not possible and the only treatment option is combined chemotherapy. This review aimed to assess the role of chemotherapy in people with advanced thymic tumours.

Main findings: We did not identify any suitable clinical trials for inclusion in this review from our search (up to July 2012). We have reported details of prospective studies that are not suitable for inclusion in the review, which provide some useful evidence about current clinical practice.

Quality of the evidence: While various treatment options are used, cisplatin-based chemotherapy is currently the usual regimen of choice, however this is not supported by good-quality trials.

Authors' conclusions: 

There were no RCTs eligible for inclusion in this review. In current practice the most common regimen for adult patients with thymic carcinoma or advanced thymoma is cisplatin-based chemotherapy. Considering the condition is rare, it is suggested that an international group is set up to organise and evaluate prospective collection of data from cohorts of patients to inform current clinical practice.

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Background: 

Thymic carcinoma or advanced thymoma is a rare cancer of the thymus gland that tends to be aggressive and infiltrate neighbouring organs, making total resection very difficult. Induction or adjuvant chemotherapy, or both, are often used in a multimodality approach to treat people affected by this condition, but the effectiveness of chemotherapy for thymic carcinoma or advanced thymoma remains uncertain.

Objectives: 

To assess the role of chemotherapy in adults with thymic carcinoma or advanced thymoma.

Search strategy: 

We searched the Cochrane Central Register of Controlled Trials (CENTRAL 2012, Issue 7), MEDLINE (accessed via Ovid from 1966 to July 2012), EMBASE (accessed via Ovid, from 1980 to July 2012), Latin American and Caribbean Literature on Health Sciences (LILACS), the Chinese Biological Medicine Database (CBM, 1978 to July 2012), China National Knowledge Infrastructure (CNKI, 1980 to July 2012) and the Chinese scientific periodical database VIP Information (VIP, 1989 to July 2012). There was no language restriction in searching for studies.

Selection criteria: 

We planned to include randomised controlled trials (RCTs) of  trials using chemotherapy (either single-agent or combination chemotherapy plus surgery, radiotherapy or not) for thymic carcinoma and/or advanced thymoma. We planned to include all adults (aged 18 years and over) diagnosed with thymic carcinoma and/or with Masaoka stage III or IV thymic tumours. The intended primary outcomes were overall survival (OS) and progression-free survival (PFS).

Data collection and analysis: 

Two review authors independently evaluated the search results according to the inclusion and exclusion criteria. There were no studies identified for inclusion and therefore no data extraction was completed.

Main results: 

No RCTs were eligible for inclusion in this review. We report details of excluded prospective studies in an additional table and try to provide some useful evidence regarding current practice.

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