Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Thoracic Oncology, Peking University Cancer Hospital & Institute, Beijing, China.
State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China.
Cancer Med. 2023 Feb;12(3):2303-2311. doi: 10.1002/cam4.5053. Epub 2022 Aug 4.
Currently there is no standard therapy recommended for second-line treatment for thymic carcinoma. Our study compared multidrug chemotherapy, single-agent chemotherapy, and PD-1 inhibitors in patients diagnosed with advanced thymic carcinoma who had previous platinum-based chemotherapy at the clinic.
The study included patients with thymic carcinoma who failed first-line platinum-based chemotherapy. Kaplan-Meier methods were applied in the study for estimating the progression-free survival (PFS) and overall survival (OS) curves. Pearson chi-square or Fisher's exact chi-square test was adopted to make comparisons of the objective response rate (ORR) between treatment groups. Cox regression was used for the multivariate analyses in PFS and OS.
Among the 92 patients enrolled, multidrug chemotherapy was used in 51 (55.4%) patients for second-line therapy. Thirty-six patients (35.9%) received single-agent chemotherapy, and eight patients (8.7%) underwent PD-1 inhibitors. The multidrug chemotherapy group showed better efficacy than the other two groups, with an ORR of 35.3% (p = 0.006). The median PFS of multidrug chemotherapy, single-agent chemotherapy and PD-1 inhibitors were 5.0 months, 3.0 months, and 4.0 months, respectively (p = 0.008). Patients in the multidrug chemotherapy group also showed an advantage in OS in comparison with the other two treatment groups (p = 0.045), with a median OS of 30.4 months. Multivariate analysis showed that second-line treatment was independent factor for both PFS (p = 0.035) and OS (p = 0.037). Grade 3-4 AEs were mostly detected in patients receiving multidrug chemotherapy and were primarily hematologic. Treatment-related mortality was not found in any of the groups.
Multidrug chemotherapy had a trend toward a more positive response rate and outcomes in longer survival time than single-agent chemotherapy and PD-1 inhibitors. Multidrug chemotherapy is a choice worth considering for second-line therapy in patients with thymic carcinoma if tolerable.
目前，对于胸腺癌的二线治疗，尚无标准疗法推荐。我们的研究比较了多药化疗、单药化疗和 PD-1 抑制剂在临床上接受过基于铂类的一线化疗后诊断为晚期胸腺癌的患者中的疗效。
该研究纳入了一线基于铂类的化疗失败的胸腺癌患者。研究中采用 Kaplan-Meier 方法估计无进展生存期（PFS）和总生存期（OS）曲线。采用 Pearson 卡方检验或 Fisher 确切概率法比较治疗组之间的客观缓解率（ORR）。采用 Cox 回归进行 PFS 和 OS 的多因素分析。
在纳入的 92 例患者中，51 例（55.4%）患者接受多药化疗作为二线治疗。36 例（35.9%）患者接受单药化疗，8 例（8.7%）患者接受 PD-1 抑制剂治疗。多药化疗组的疗效优于其他两组，ORR 为 35.3%（p=0.006）。多药化疗、单药化疗和 PD-1 抑制剂组的中位 PFS 分别为 5.0 个月、3.0 个月和 4.0 个月（p=0.008）。与其他两组相比，多药化疗组患者的 OS 也有优势（p=0.045），中位 OS 为 30.4 个月。多因素分析显示，二线治疗是 PFS（p=0.035）和 OS（p=0.037）的独立因素。多药化疗组主要为血液学 3-4 级 AE，单药化疗和 PD-1 抑制剂组未见治疗相关死亡。
多药化疗在缓解率和生存时间方面有更积极的趋势，优于单药化疗和 PD-1 抑制剂。如果耐受，多药化疗是胸腺癌二线治疗的一种值得考虑的选择。
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