Appointment sheet
Thymic carcinoma
Prepared with OnCo (onco.cc/prep/thymic-carcinoma/). Orientation, not medical advice; your team knows your case.
My details
Name
Date of appointment
Hospital and clinician
Who is coming with me
What I know, what is unclear, changes to discuss
Saved in this browserWhat I know so far
What is unclear to me
Changes since last time
My questions
19 on the sheetNewly diagnosed
- 1.What is my exact diagnosis, stage, and grade, and which tests established them?
- 2.Which biomarkers have been tested on my tumour (for example Histological subtype and CD5, CD117and p63 immunohistochemistry, TNM and Masaoka-Koga stage, Completeness of resection, KIT mutation, PD-L1 expression), and what were the results?
- 3.Which subtype is my cancer, and does that change the recommended treatment?
- 4.Is germline (inherited) genetic testing recommended for me or my family?
Resectable disease
- 5.For my situation (resectable disease), which of the standard options do you recommend and why?
Borderline resectable
- 6.For my situation (borderline resectable), which of the standard options do you recommend and why?
- 7.Am I a candidate for Carboplatin, Paclitaxel / nab-paclitaxel, Cisplatin or related drugs, and what side effects should I expect?
Advanced, first line
- 8.For my situation (advanced, first line), which of the standard options do you recommend and why?
- 9.Am I a candidate for Carboplatin, Paclitaxel / nab-paclitaxel, and what side effects should I expect?
After platinum
- 10.For my situation (after platinum), which of the standard options do you recommend and why?
- 11.Am I a candidate for Sunitinib, Lenvatinib, Pembrolizumab or related drugs, and what side effects should I expect?
Trials
- 12.For my situation (trials), which of the standard options do you recommend and why?
- 13.Am I a candidate for KC1036, EB-CAR30-NK, and what side effects should I expect?
- 14.How do the results of A Study of KC1036 in Patients with Advanced Thymic Tumors and Sacituzumab Tirumotecan in Participants With Locally Advanced or Metastatic Thymic Carcinoma apply to someone like me?
Any stage
- 15.Are there clinical trials I could join, for example of Lenvatinib, Sunitinib, Pembrolizumab, KC1036?
- 16.Would a second opinion at a high-volume centre change anything, and can you help arrange it?
- 17.What supportive care (symptom control, nutrition, exercise, mental health, financial help) is available from the start?
- 18.I read that “No randomised trial has compared any two regimens in thymic carcinoma”. How does that affect my plan?
- 19.I read that “The sequence of kinase inhibitors and immunotherapy is unstudied”. How does that affect my plan?
The words I may hear
- Disease-specific staging and risk systems (FIGO, Ann Arbor, IPI, R-ISS, ELN, IMDC): Beyond the generic TNM system, gynaecological cancers (FIGO), lymphoma (Ann Arbor, IPI), myeloma (R-ISS), AML (ELN), kidney cancer (IMDC), neuroblastoma (INRG) and CLL (Rai, Binet) each have their own system that combines stage, blood tests, genetics and fitness into risk groups.
- Immune-related adverse events (irAEs): Immune-related adverse events (irAEs) are the autoimmune side effects of checkpoint inhibitors: colitis, thyroid problems, rash, hepatitis, pneumonitis.
- Tumour mutational burden (TMB): How many mutations a tumour has.
Tests and results to bring
Biomarker results to ask for: Histological subtype and CD5, CD117 (KIT) and p63 immunohistochemistry, TNM and Masaoka-Koga stage, Completeness of resection, KIT mutation (imatinib-responsive subset), PD-L1 expression (high in many; not required for pembrolizumab), Baseline troponin and autoimmune screen before PD-1 therapy.
Bring copies of scan reports, pathology and blood results, and a list of every medicine and supplement.
The treatments I may be offered
- Resectable disease: Complete resection with thymectomy and involved structures; postoperative radiotherapy for all stages of thymic carcinoma; chemotherapy considered after incomplete resection. (Robotic & minimally invasive surgery, IMRT / IGRT (modern external beam), Proton therapy)
- Borderline resectable: Induction chemotherapy (carboplatin-paclitaxel or CAP) followed by surgery or radiotherapy according to response. (Carboplatin, Paclitaxel / nab-paclitaxel, Cisplatin, Doxorubicin, Cyclophosphamide)
- Advanced, first line: Carboplatin and paclitaxel; CAP or platinum-etoposide as alternatives. (Carboplatin, Paclitaxel / nab-paclitaxel, Cytotoxic chemotherapy)
- Trials: KC1036, sacituzumab tirumotecan, CAR-NK cells, ramucirumab combinations. (A Study of KC1036 in Patients with Advanced Thymic Tumors, Sacituzumab Tirumotecan in Participants With Locally Advanced or Metastatic Thymic Carcinoma, Target-Selected CAR-NK Cells (CD30, CD5, or Mesothelin) for Relapsed/Refractory B2 Thymoma or Thymic Carcinoma, KC1036, EB-CAR30-NK)
- After platinum: Sunitinib; lenvatinib (approved in Japan, REMORA); pembrolizumab with cardiac and autoimmune monitoring; everolimus; imatinib for KIT-mutant tumours. (Sunitinib, Lenvatinib, Pembrolizumab, Everolimus, Imatinib, Immune-related adverse events (irAEs), Small-molecule kinase inhibitors, Immune checkpoint inhibitors)
From the standard of care recorded for this cancer; which apply depends on your stage and biomarkers. Ask which the team recommends and why.
Answers and next steps
Saved in this browserWhat I was told
Agreed next steps, dates and who to call