Research in thymus cancer

We are always learning more about cancer. Researchers and healthcare professionals use what they learn from research studies to develop better practices that will help treat thymus cancer.

The following is a selection of research showing promise in treating and studying thymoma and thymic carcinoma. We’ve included information from PubMed, which is the research database of the National Library of Medicine (NLM). Each research article in PubMed has an identity number (called a PMID) that links to a brief overview (called an abstract). We have also included links to abstracts of the research presented at meetings of the American Society of Clinical Oncology (ASCO), which are held throughout the year. You can find information about ongoing clinical trials in Canada from CanadianCancerTrials.ca and ClinicalTrials.gov. Clinical trials are given an NLM identifier called a national clinical trial (NCT) number. The NCT number links to information about the clinical trial.

Treatment

Researchers are looking for new ways to improve treatment for thymus cancer. Advances in cancer treatment and new ways to manage the side effects from treatment have improved the outlook and quality of life for many people with cancer. The following is noteworthy research into treatment for thymus cancer.

Surgery

Doctors are looking at new ways of doing surgery that cause less injury to the body (called minimally invasive surgery) and fewer complications.

Video-assisted thoracoscopic surgery (VATS) is a type of thoracoscopy. There is a small video camera attached to the thoracoscope to help guide surgeons as they remove tissue from the chest. VATS can be used to remove part or all of the thymus (called a thymectomy). Researchers compared VATS to a traditional open thymectomy in people with early stage thymus cancer. They found that VATS is safe and has better surgical outcomes, including less blood loss and a shorter hospital stay. The survival rate was similar for both approaches to surgery (Journal of Thoracic Disease, PMID 27114834; Journal of Thoracic Oncology, PMID 26762737; Annals of Surgical Oncology, PMID 25256127).

Chemotherapy

Chemotherapy is mainly used to treat stage 4 and recurrent thymus cancer. Researchers continue to look for ways to improve how effective it is in treating thymus cancer.

Neoadjuvant chemotherapy or chemoradiation may be an option for stage 3 or stage 4 thymomas and thymic carcinomas that can’t be removed with surgery (called unresectable tumours). Researchers found that giving chemotherapy or chemoradiation to these tumours increased the chance that they could be completely removed with surgery (Journal of Thoracic Oncology, PMID 23722169; The Journal of Thoracic and Cardiovascular Surgery, PMID 24139613; ClinicalTrials.gov, NCT02636556).

Certain combinations of chemotherapy drugs help treat and improve survival for thymus cancer. Researchers found this was true for the following combinations: cisplatin (Platinol AQ) and gemcitabine (Gemzar), carboplatin (Paraplatin, Paraplatin AQ) and paclitaxel (Taxol), and capecitabine (Xeloda) and gemcitabine (Thoracic Cancer, PMID 27042218; Annals of Oncology, PMID 25403584; Future Oncology, PMID 25471029).

Heated chemotherapy given directly into the chest is called hyperthermic intrathoracic chemotherapy perfusion. Researchers looked at giving this treatment after surgery for advanced thymus cancer. Some studies show that it helped control growth of the cancer and improve long-term survival (OncoTargets and Therapy, PMID 23690692; European Journal of Cardio-Thoracic Surgery, PMID 22885228; ClinicalTrials.gov, NCT01163552).

Radiation therapy

Giving radiation therapy after surgery is called adjuvant radiation therapy. Researchers are studying the following specialized types of radiation therapy as adjuvant therapy to see if they can improve survival for thymus cancer.

Intensity-modulated radiation therapy (IMRT) and 3-D conformal radiation therapy (3-D CRT) allow doctors to accurately target the tumour without damaging the normal tissue around it. A small study looked at giving IMRT or 3-D CRT after surgery for stage 3 thymoma. It found that, compared to conventional radiation therapy, these treatments improved survival. In addition, fewer cancers came back (recurred) after IMRT or 3-D CRT (Radiation Oncology, PMID 23937886).

Proton beam radiation therapy uses high-energy, or charged, proton particles. These particles can be aimed more precisely at the tumour than the x-ray beams used in conventional radiation therapy. Research shows that proton beam radiation therapy can control the growth of thymus cancer with few side effects. It also causes less damage to nearby tissues (such as the lungs, heart and esophagus) than IMRT. More research is needed to study the long-term response to and side effects from proton beam radiation therapy (Radiotherapy and Oncology, PMID 26895711; Clinical Lung Cancer, PMID 27372386).

Targeted therapy

Researchers are studying the following types of targeted therapy drugs to see if they can stop the growth of thymus cancer cells. Most of the research studies are in early phases, so their results may not be available. But some studies show that these drugs may be effective in treating advanced thymus cancer or thymus cancer that doesn’t respond to chemotherapy (called refractory cancer).

Monoclonal antibodies are substances that find and bind to particular target molecules on cancer cells. By blocking the target molecule, these drugs can interfere with how the cell works. Researchers are studying the following monoclonal antibodies as treatment for thymus cancer: bevacizumab (Avastin), cetuximab (Erbitux), pembrolizumab (Keytruda) and cixutumumab (ClinicalTrials.gov, NCT00369889, NCT01025089, NCT02607631; The Lancet Oncology, PMID 24439931).

Protein kinase inhibitors block chemicals called kinases. These chemicals are part of the signalling process within cells. When this process is blocked, the cell stops growing and dividing. Erlotinib (Tarceva), sunitinib (Sutent), saracatinib and milciclib are some protein kinase inhibitors that researchers are studying for thymus cancer (The Lancet Oncology, PMID 25592632; Lung Cancer, PMID 26009269; ASCO, Abstract 7526).

Histone deacetylase inhibitors prevent cells from growing and dividing by blocking a group of enzymes called histone deacetylases. Researchers found that the histone deacetylase inhibitor belinostat combined with chemotherapy may be an effective treatment for advanced and unresectable thymus tumours (Clinical Cancer Research, PMID 25189481).

Molecular profiling

Molecular profiling is a type of testing that looks at the unique features of the genes in cancer cells, as well as any related biomarkers. Researchers hope that molecular profiling will help doctors predict a prognosis and find the best treatments for certain cancers. Molecular profiling will also help doctors create targeted therapies for each cancer based on the specific genetic makeup of the tumour. A clinical trial found that researchers were better able to study and find abnormal genes in thymus cancer using molecular profiling (Journal of Clinical Oncology, PMID 25667274; ClinicalTrials.gov, NCT01306045).

Learn more about cancer research

Researchers continue to try to find out more about thymus cancer. Clinical trials are research studies that test new ways to prevent, detect, treat or manage thymus cancer. Clinical trials provide information about the safety and effectiveness of new approaches to see if they should become widely available. Most of the standard treatments for thymus cancer were first shown to be effective through clinical trials.

Find out more about clinical trials.

Expert review and references

  • Besse B, Garassino MC, Rajan A et al . A phase II study of milciclib (PHA-848125AC) in patients with thymic carcinoma. 2014 ASCO Annual Meeting. Alexandria, VA: American Society of Clinical Oncology; 2014: http://meetinglibrary.asco.org/content/131226-144.
  • Chao YK, Liu YH, Hsieh MJ et al . Long-term outcomes after thoracoscopic resection of stage I and II thymoma: a propensity-matched study. Annals of Surgical Oncology. 2015.
  • Fan C, Feng Q, Chen Y et al . Postoperative radiotherapy for completely resected Masaoka stage III thymoma: a retrospective study of 65 cases from a single institution. Radiation Oncology. 2013: http://ro-journal.biomedcentral.com/articles/10.1186/1748-717X-8-199.
  • Friedant AJ, Handorf EA, Su S, Scott WJ . Minimally invasive versus open thymectomy for thymic malignancies: systematic review and meta-analysis. Journal of Thoracic Oncology. 2016.
  • Gubens MA, Burns M, Perkins SM et al . A phase II study of saracatinib (AZD0530), a Src inhibitor, administered orally daily to patients with advanced thymic malignancies. Lung Cancer. 2015.
  • Hirai F, Yamanaka T, Taguchi K et al . A multicenter phase II study of carboplatin and paclitaxel for advanced thymic carcinoma: WJOG4207L. Annals of Oncology. 2015: http://annonc.oxfordjournals.org/content/26/2/363.long.
  • Korst RJ, Bezjak A, Blackmon S et al . Neoadjuvant chemoradiotherapy for locally advanced thymic tumors: a phase II, multi-institutional clinical trial. Journal of Thoracic and Cardiovascular Surgery. 2014: http://www.jtcvsonline.org/article/S0022-5223(13)01043-X/fulltext.
  • Lopez-Chavez A, Thomas A, Rajan A et al . Molecular profiling and targeted therapy for advanced thoracic malignancies: a biomarker-derived, multiarm, multihistology phase II basket trial. Journal of Clinical Oncology. 2015: http://jco.ascopubs.org/content/33/9/1000.long.
  • Luo Y, Li JL, Yang L, Zhang W . Chemotherapy with gemcitabine plus cisplatin in patients with advanced thymic squamous cell carcinoma: evaluation of efficacy and toxicity. Thoracic Cancer. 2016: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4773311/.
  • Palmieri G, Buonerba C, Ottaviano M et al . Capecitabine plus gemcitabine in thymic epithelial tumors: final analysis of a Phase II trial. Future Oncology. 2014.
  • Parikh RR, Rhome R, Hug E et al . Adjuvant proton beam therapy in the management of thymoma: a dosimetric comparison and acute toxicities. Clinical Lung Cancer. 2016.
  • Park S, Ahn MJ, Ahn JS et al . A prospective phase II trial of induction chemotherapy with docetaxel/cisplatin for Masaoka stage III/IV thymic epithelial tumors. Journal of Thoracic Oncology. 2013: http://www.jto.org/article/S1556-0864(15)32881-1/fulltext.
  • Rajan A, Carter CA, Berman A et al . Cixutumumab for patients with recurrent or refractory advanced thymic epithelial tumours: a multicentre, open-label, phase 2 trial. Lancet Oncology. 2014: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3954701/.
  • Ried M, Potzger T, Braune N et al . Cytoreductive surgery and hyperthermic intrathoracic chemotherapy perfusion for malignant pleural tumours: perioperative management and clinical experience. European Journal of Cardio-Thoracic Surgery. 2013: http://ejcts.oxfordjournals.org/content/43/4/801.long.
  • Thomas A, Rajan A, Berman A et al . Sunitinib in patients with chemotherapy-refractory thymoma and thymic carcinoma: an open-label phase 2 trial. Lancet Oncology. 2015: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4401497/.
  • Thomas A, Rajan A, Szabo E et al . A phase I/II trial of belinostat in combination with cisplatin, doxorubicin, and cyclophosphamide in thymic epithelial tumors: a clinical and translational study. Clinical Cancer Research. 2014: http://clincancerres.aacrjournals.org/content/20/21/5392.long.
  • US National Institutes of Health. ClinicalTrials.gov.
  • Vogel J, Berman AT, Lin L et al . Prospective study of proton beam radiation therapy for adjuvant and definitive treatment of thymoma and thymic carcinoma: Early response and toxicity assessment. Radiotherapy and Oncology. 2016.
  • Wang H, Gu Z, Ding J et al . Perioperative outcomes and long-term survival in clinically early-stage thymic malignancies: video-assisted thoracoscopic thymectomy versus open approaches. Journal of Thoracic Disease. 2016: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4824723/.
  • Yu L, Jing Y, Ma S, Li F, Zhang YF . Cytoreductive surgery combined with hyperthermic intrapleural chemotherapy to treat thymoma or thymic carcinoma with pleural dissemination. OncoTargets and Therapy. 2013: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3656918/.