Loading
Thymic carcinoma is the aggressive kind of thymic epithelial tumour, a cancer of the thymus that behaves like carcinoma elsewhere and has often spread when found. Surgery is attempted when possible, carboplatin with paclitaxel is the usual chemotherapy, and sunitinib, lenvatinib and the PD-1 antibody pembrolizumab have shown responses in trials, with lenvatinib approved in Japan.
Thymic carcinoma differs from thymoma in every way that matters: its cells are overtly malignant, it lacks the immature T lymphocytes and the organotypic features of thymoma, it is rarely associated with myasthenia gravis, and it presents with local invasion, pleural spread or distant metastases in most patients. Squamous cell carcinoma is the commonest subtype, followed by lymphoepithelioma-like, basaloid, mucoepidermoid, sarcomatoid and NUT carcinoma (covered on its own page); thymic neuroendocrine carcinomas are classified separately. KIT mutations occur in about a tenth of thymic carcinomas, mostly squamous, and respond to imatinib in case series, and TP53, CDKN2A and epigenetic regulator mutations are common; PD-L1 is often highly expressed.
Complete resection is attempted for localised disease, followed by postoperative radiotherapy, and chemotherapy is given before surgery for borderline tumours. For advanced disease the guidelines favour carboplatin and paclitaxel, which produced responses in about a fifth of patients with thymic carcinoma in prospective series, with CAP or platinum-etoposide as alternatives. After platinum, three phase 2 trials define the options: sunitinib (Lancet Oncology 2015) produced responses in about a quarter of 23 patients with thymic carcinoma; lenvatinib in the Japanese REMORA trial (Lancet Oncology 2020) produced responses in 38 percent of 42 patients and was approved in Japan in 2021; and pembrolizumab (Lancet Oncology 2018) produced responses in 22.5 percent of 40 patients with durable benefit but severe immune-related adverse events, including myocarditis, in 15 percent, a rate high enough that PD-1 antibodies are used only with monitoring and are avoided in thymoma. Newer agents in trials include the multikinase inhibitor KC1036, the TROP2 antibody-drug conjugate sacituzumab tirumotecan, ramucirumab with carboplatin and paclitaxel, and CAR-NK cells against CD30 or mesothelin.
About a fifth of thymic epithelial tumours; usually found at an advanced stage with invasion of the mediastinum or spread to pleura, nodes and distant organs, and rarely tied to myasthenia gravis.
Central tumours arise in the large airways, peripheral ones in the alveoli; both drain to hilar then mediastinal nodes, and the pleural lining is a separate cancer site.
Same organ: Mediastinal germ cell tumour, Pleuropulmonary blastoma (types I, Ir, II and III), Type A and type AB thymoma, Type B1 and type B2 thymoma, Type B3 thymoma, Micronodular thymoma with lymphoid stroma, Adenocarcinoma of the lung, Squamous cell carcinoma of the lung, Large cell carcinoma of the lung, Sarcomatoid carcinoma of the lung, Adenosquamous carcinoma of the lung, Invasive mucinous adenocarcinoma of the lung, Adenocarcinoma in situ and minimally invasive adenocarcinoma of the lung, Basaloid squamous cell carcinoma of the lung, Lymphoepithelial carcinoma of the lung, Pulmonary blastoma (adult), Non-small-cell lung cancer, Lung cancer (all types), Small-cell lung cancer, Mesothelioma, Pleural mesothelioma, Thymoma and thymic carcinoma, Childhood lung and airway tumours (pleuropulmonary blastoma, tracheobronchial tumours), Inflammatory myofibroblastic tumour (IMT), EGFR-mutated non-small-cell lung cancer, ALK-positive non-small-cell lung cancer, KRAS G12C-mutant non-small-cell lung cancer, ROS1-positive non-small-cell lung cancer, MET exon 14 and MET-amplified non-small-cell lung cancer, RET fusion-positive non-small-cell lung cancer, BRAF V600E-mutant non-small-cell lung cancer, HER2-mutant non-small-cell lung cancer, NTRK fusion-positive non-small-cell lung cancer, PD-L1-high non-small-cell lung cancer without a driver mutation, Resectable stage I to III non-small-cell lung cancer, Unresectable stage III non-small-cell lung cancer, Limited-stage small-cell lung cancer, Extensive-stage small-cell lung cancer, Lung neuroendocrine tumours (typical and atypical carcinoid), Large cell neuroendocrine carcinoma of the lung, Thymoma (WHO types A, AB, B1, B2 and B3)
Complete resection with thymectomy and involved structures; postoperative radiotherapy for all stages of thymic carcinoma; chemotherapy considered after incomplete resection.
Induction chemotherapy (carboplatin-paclitaxel or CAP) followed by surgery or radiotherapy according to response.
Carboplatin and paclitaxel; CAP or platinum-etoposide as alternatives.
Sunitinib; lenvatinib (approved in Japan, REMORA); pembrolizumab with cardiac and autoimmune monitoring; everolimus; imatinib for KIT-mutant tumours.
KC1036, sacituzumab tirumotecan, CAR-NK cells, ramucirumab combinations.
Country and place are remembered in this browser only. A postcode is sent to OpenStreetMap's Nominatim service to find coordinates when you press the button; nothing else leaves your device.
The names on a thymic pathology report, and the sharp line between thymoma and thymic carcinoma that drives treatment, come from this classification.
Lenvatinib is one of the few drugs with prospective evidence in thymic carcinoma after chemotherapy, alongside sunitinib and pembrolizumab.
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.
The thymoma and thymic carcinoma pages follow this guideline for who gets surgery, radiotherapy and chemotherapy; its central message is that these rare tumours should be discussed in an expert network.
Query for this cancer: (TITLE:"Thymic carcinoma" OR ABSTRACT:"Thymic carcinoma" OR TITLE:"Thymic squamous cell carcinoma" OR ABSTRACT:"Thymic squamous cell carcinoma" OR TITLE:"Type C thymoma obsolete" OR ABSTRACT:"Type C thymoma obsolete" OR TITLE:"Malignant thymic epithelial tumour" OR ABSTRACT:"Malignant thymic epithelial tumour") AND (treatment OR therapy OR trial OR survival OR diagnosis). Results are unfiltered search hits about Thymic carcinoma, not a curated reading list.
The targets of this cancer's medicines and the ones linked to it directly.
Cases by country, the UK and NHS pathway and other country lenses, the expert centres with trials on record, and the centres named on this cancer's subtypes.
One section per setting: the options named, what each is for, the trials behind them, the recorded trade-offs and the questions to ask.
Bleeding that does not stop by itself, bleeding from more than one site, or new bruising in several places or one large area.
Fainting, near-fainting, or an irregular or racing heartbeat; several kinase inhibitors prolong the QT interval and the labels require ECG and electrolyte monitoring.
Sudden severe abdominal pain, a hard or very tender abdomen, or abdominal pain with vomiting and fever. Boxed warning for gastrointestinal perforation on bevacizumab.
Persistent headache with extreme tiredness, nausea, dizziness on standing or low blood pressure. Vomiting, severe weakness or collapse is adrenal crisis.
QT: both Sunitinib and Lenvatinib prolong the QT interval (known and known risk).. Avoid other QT-prolonging drugs where possible; check ECG and correct potassium and magnesium before and during treatment.
Cumulative dose: risk rises steeply above 400-550 mg/m² (see the anthracycline calculator).
See all on the product pages:CarboplatinCisplatinCyclophosphamideDoxorubicinImatinibLenvatinibPaclitaxel / nab-paclitaxelPembrolizumabSunitinib·Printable cards in the navigator
Newly diagnosed? Read the first 60 days with Thymic carcinoma, then print the one-page appointment sheet with room for the answers.
Print this page for your appointment (your browser's print command). These prompts are for discussion; your clinical team knows your case.
Everything in development, the medicines held by this cancer's subtypes, the open problems and what is being done about them, the roadmaps, and what changed on this record.
Every connected record, the notes, the JSON, Markdown and RDF twins, and where the record came from and when it was checked.