Thymomas and Thymic Carcinomas Treatment Regimens

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THYMOMA AND THYMIC CARCINOMA TREATMENT REGIMENS

Clinical Trials: The NCCN recommends cancer patient participation in clinical trials as the gold standard for treatment.

Cancer therapy selection, dosing, administration, and the management of related adverse events can be a complex process that should be handled by an experienced healthcare team. Clinicians must choose and verify treatment options based on the individual patient; drug dose modifications and supportive care interventions should be administered accordingly. The thymomas and thymic carcinoma cancer treatment regimens below may include both U.S. Food and Drug Administration-approved and unapproved indications/regimens. These thymomas and thymic carcinoma cancer treatment regimens are provided only to supplement the latest treatment strategies.

These Cancer Treatment Guidelines are a work in progress that may be refined as often as new significant data becomes available. The NCCN Guidelines® are a consensus statement of its authors regarding their views of currently accepted approaches to treatment. Any clinician seeking to apply or consult any NCCN Guidelines® is expected to use independent medical judgment in the context of individual clinical circumstances to determine any patient's care or treatment. The National Comprehensive Cancer Network makes no warranties of any kind whatsoever regarding their content, use, or application and disclaims any responsibility for their application or use in any way.

(Revised 10/2016)

© 2016 by Haymarket Media, Inc.

Systemic Therapy

Note: All recommendations are Category 2A unless otherwise indicated.

First-Line Combination Chemotherapy Regimens1

REGIMEN

DOSING

CAP (preferred for thymoma)2

Day 1: Cisplatin 50mg/m2 IV + doxorubicin 50mg/m2 IV + cyclophosphamide 500mg/m2 IV.

Repeat every 21 days for a max of 8 cycles.

CAP with prednisone3

Day 1: Cyclophosphamide 500mg/m2 IV

Days 1–3: Cisplatin 30mg/m2 IV

Days 1–3: Doxorubicin 20mg/m2 via 24-hour continuous IV infusion

Days 1–5: Prednisone 100mg.

Repeat every 3 weeks for 3 cycles.

ADOC4

Day 1: Cisplatin 50mg/m2 IV + doxorubicin 40mg/m2 IV

Day 3: Vincristine 0.6mg/m2 IV

Day 4: Cyclophosphamide 700mg/m2 IV.

Repeat every 3 weeks for 5 cycles.

PE5

Day 1: Cisplatin 60mg/m2 IV over 1 hour

Days 1–3: Etoposide 120mg/m2 IV over 30 minutes.

Repeat every 3 weeks for a max of 8 cycles.

VIP6

Days 1–4: Etoposide 75mg/m2 IV + ifosfamide 1.2g/m2 IV + cisplatin 20mg/m2 IV.

Repeat every 3 weeks for 4 cycles.

Carboplatin + paclitaxel (preferred for thymic carcinoma)7

Day 1: Paclitaxel 225mg/m2 IV over 3 hours followed by carboplatin AUC = 6 IV over 30 minutes.

Repeat every 3 weeks for a max of 6 cycles.

Second-Line Chemotherapy1

Etoposide5

Days 1–3: Etoposide 120mg/m2 IV over 30 minutes.

Repeat every 3 weeks for a max of 8 cycles.

Ifosfamide8

Days 1–5: Ifosfamide 1.5g/m2 IV.

Repeat every 3 weeks for a max of 9 cycles.

Pemetrexed9

Day 1: Pemetrexed 500mg/m2 IV.

Repeat every 3 weeks for a max of 6 cycles.

Octreotide (including LAR) ± prednisone10

Octreotide 0.5 mg SQ TID ± prednisone 0.6 mg/kg/day.

Treat for a maximum of 1 year.

5-FU + leucovorin11

Days 1–5: 5-FU 300–370mg/m2 IV + leucovorin 200mg/m2 IV rapid infusion.

Repeat every 28 days.

Gemcitabine12

Days 1, 8, and 15: Gemcitabine 1000mg/m2 IV over 30 minutes.

Repeat every 28 days in patients with acceptable toxicity and no evidence of disease progression.

Paclitaxel13

Days 1, 8, 15, 22, 29, and 36: Paclitaxel 80mg/m2 IV.

Repeat every 8 weeks until tumor response.

Sunitinib (thymic carcinomas only)14

Sunitinib 50mg orally once daily for 4 weeks, followed by 2 weeks off.

Repeat every 6 weeks until disease progression.

Everolimus15

Everolimus 10mg orally once daily.

Continue treatment until disease progression or unacceptable toxicity.

References

1. Referenced with permission from the NCCN Clinical Practice Guidelines in Oncology (NCCNGuidelines®) for Thymomas and Thymic Carcinomas. V3.2016. Available at: http://www.nccn.org. Accessed September 16, 2016.

2. Loehrer P, Kim K, Aisner S, et al. Cisplatin plus doxorubicin plus cyclophosphamide in metastatic or recurrent thymoma: final results of an intergroup trial. The Eastern Cooperative Oncology Group, Southwest Oncology Group, and Southeastern Cancer Study Group. J Clin Oncol. 1994;12:1164–1168.

3. Kim E, Putnam J, Komaki R, et al. Phase II study of a multidisciplinary approach with induction chemotherapy, followed by surgical resection, radiation therapy, and consolidation chemotherapy for unresectable malignant thymomas: final report. Lung Cancer. 2004;44:369–379.

4. Fornasiero A, Daniele O, Ghiotto C, et al. Chemotherapy for invasive thymoma. A 13-year experience. Cancer. 1991;68:30–33.

5. Giaccone G, Ardizzoni A, Kirkpatrick A, et al. Cisplatin and etoposide combination chemotherapy for locally advanced or metastatic thymoma. A phase II study of the European Organization for Research and Treatment of Cancer Lung Cancer Cooperative Group. J Clin Oncol. 1996;14:814–820.

6. Loehrer P, Jiroutek M, Aisner S, et al. Combined etoposide, ifosfamide, and cisplatin in the treatment of patients with advanced thymoma and thymic carcinoma: an intergroup trial. Cancer. 2001;91:2010–2015.

7. Lemma G, Lee J, Aisner S, et al. Phase II study of carboplatin and paclitaxel in advanced thymoma and thymic carcinoma. J Clin Oncol. 2011;29:2060–2065.

8. Highley M, Underhill C, Parnis F, et al. Treatment of invasive thymoma with single-agent ifosfamide. J Clin Oncol. 1999;17:2737–2744.

9. Loehrer P, Yiannoutsos C, Dropcho S, et al. A phase II trial of pemetrexed in patients with recurrent thymoma or thymic carcinoma [abstract]. J Clin Oncol. 2006;24(Suppl 18): Abstract 7079.

10. Loehrer P, Wang W, Johnson D, et al. Octreotide alone or with prednisone in patients with advanced thymoma and thymic carcinoma: an Eastern Cooperative Oncology Group Phase II Trial. J Clin Oncol. 2004;22:293–299.

11. Stewart D, Dahrouge S, Soltys K, Evans W. A phase II study of 5-fluorouracil plus high-dose folinic acid in the treatment of recurrent small cell lung cancer. Am J Clin Oncol. 1995;18:130–132.

12. Masters G, Declerck L, Blanke C, et al. Phase II trial of gemcitabine in refractory or relapsed small-cell lung cancer: Eastern Cooperative Oncology Group Trial 1597. J Clin Oncol. 2003;21:1550–1555.

13. Yamamoto N, Tsurutani J, Yoshimura N, et al. Phase II study of weekly paclitaxel for relapsed and refractory small cell lung cancer. Anticancer Res. 2006;26:777–781.

14. Thomas A, Rajan A, Berman AW, et al. Phase II trial of sunitinib in patients with thymic epithelial tumors (TET) [abstract]. J Clin Oncol. 2014;32(suppl 5): Abstract 7525.

15. Zucali PA, De Pas TM, Palmieri G, et al. Phase II study of everolimus in patients with thymoma and thymic carcinoma previously treated with cisplatin-based chemotherapy [abstract]. J Clin Oncol. 2014;32(suppl 5):Abstract 7527.


Drug Monographs

Cisplatin Doxorubicin Cyclophosphamide
Prednisone Vincasar PFS Toposar
Ifex Taxol Carboplatin
Leucovorin Gemzar Sutent

Data provided by MPR.

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