Immune checkpoint blockers in patients with unresectable or metastatic thymic epithelial tumours: A meta-analysis

• Published in: European journal of cancer (1990) Vol. 180; pp. 117 - 124
• Main Authors: Remon, Jordi, Villacampa, Guillermo, Facchinetti, Francesco, Di Maio, Massimo, Marcuse, Florit, Tiseo, Marcello, Hochstenbag, Monique, Hendriks, Lizza E.L., Besse, Benjamin
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01-02-2023; Elsevier Science Ltd
• Subjects: Advanced thymic epithelial tumours; Atezolizumab; Avelumab; Cancer; Chemotherapy; Clinical trials; Clinical Trials, Phase I as Topic; Clinical Trials, Phase II as Topic; Effectiveness; Humans; Immune checkpoint; Immune checkpoint blockers; Immune Checkpoint Inhibitors - adverse effects; Meta-analysis; Metastases; Metastasis; Neoplasms, Glandular and Epithelial - drug therapy; Neoplasms, Glandular and Epithelial - pathology; Nivolumab; Patients; Pembrolizumab; Platinum; Platinum - therapeutic use; Strategy; Survival; Thymoma; Thymoma - drug therapy; Thymus; Thymus Neoplasms - drug therapy; Thymus Neoplasms - pathology; Toxicity; Tumors; Immune checkpoint blockers; Avelumab; Pembrolizumab; Nivolumab; Advanced thymic epithelial tumours; Atezolizumab
• ISSN: 0959-8049; 1879-0852
• DOI: 10.1016/j.ejca.2022.12.005

For patients with advanced thymic epithelial tumours (TET), there is no standard second-line treatment after platinum-based chemotherapy. Although immune checkpoint blockers (ICB) are a potential treatment strategy, their efficacy seems limited with an increased risk of immune-related adverse events (ir-AEs), thus hampering their application in daily clinical practice.
We performed a meta-analysis to better evaluate the existing evidence about the activity and safety of ICB in the setting of unresectable or metastatic advanced TET previously treated with platinum-based chemotherapy.
Six phase I/II trials met the eligibility criteria including a total of 166 evaluable patients (77% thymic carcinoma, 23% thymoma) evaluable for activity after being treated with pembrolizumab, nivolumab, avelumab or atezolizumab. The overall response rate to ICB was 18.4% (95% CI: 12.3–26.5), and the one-year progression-free survival rate and one-year overall survival rate were 26.0% (95% CI: 19.6–34.6) and 66.9% (95% CI: 59.6–75.2%), respectively. The incidence of grade 3–5 ir-AEs was 26.4%, with 17.1% in thymic carcinoma and 58.3% in thymoma.
Despite the absence of a robust demonstration of efficacy in the context of randomised trials, our results suggest ICB as a potential strategy in patients with pretreated TET, mainly among patients with thymic carcinoma. Close monitoring is strongly advised to detect severe immune-toxicity.
•Immune checkpoint blockers strategy is feasible in pre-treated thymic carcinomas.•In this population, ICB achieve a RR of 18% and one-year OS of 67%.•Close monitoring of patients is strongly advised to detect severe immune-toxicity.