Pembrolizumab in patients with thymic carcinoma: a single-arm phase 2 study
Immunotherapy shrank thymic carcinoma in about one patient in five after chemotherapy, but caused severe immune attacks on the heart and muscle more often than in other cancers, so it is used with care.
Overview
Single-centre phase 2 study of 40 patients with recurrent thymic carcinoma after at least one line of chemotherapy, treated with pembrolizumab every three weeks.
The objective response rate was 22.5 percent with a median progression-free survival of 4.2 months and durable responses in a subset; 15 percent of patients had severe autoimmune toxicity including myocarditis, myositis and hepatitis, higher than in most tumour types. Patients with thymoma were excluded because of this risk.
- Objective response 22.5 percent; median progression-free survival 4.2 months.
- Severe immune-related adverse events, including myocarditis, in 15 percent of patients.
PD-1 blockade is an option for thymic carcinoma after chemotherapy in expert centres, with close monitoring for myocarditis; it is not used in thymoma because of autoimmunity.
- Single-arm, single-centre study.
- The rate of serious autoimmune toxicity is much higher than in other cancers.
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