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10 slides generated from the cancer page, with a quiz from the open benchmark and speaker notes that cite the sources. Arrow keys move between slides; Print gives one slide per page.
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.
| Setting | Approach | Guideline |
|---|---|---|
| Resectable disease | Complete resection with thymectomy and involved structures; postoperative radiotherapy for all stages of thymic carcinoma; chemotherapy considered after incomplete resection. | not mapped |
| Borderline resectable | Induction chemotherapy (carboplatin-paclitaxel or CAP) followed by surgery or radiotherapy according to response. | not mapped |
| Advanced, first line | Carboplatin and paclitaxel; CAP or platinum-etoposide as alternatives. | not mapped |
| After platinum | Sunitinib; lenvatinib (approved in Japan, REMORA); pembrolizumab with cardiac and autoimmune monitoring; everolimus; imatinib for KIT-mutant tumours. | not mapped |
| Trials | KC1036, sacituzumab tirumotecan, CAR-NK cells, ramucirumab combinations. | not mapped |