Abstract
AB003. Unexpected long-lasting control of thymic carcinoma treated with anti-PD1 and oral etoposide: a real-life experience of combination therapy
Margaret Ottaviano1,2#, Sara Parola3#, Giuseppe Neola3, Angela Grieco3, Erica Pietroluongo3, Pietro De Placido3, Marianna Tortora1, Mariarosaria Saponaro3, Rocco Morra3, Anna Piscopo3, Antonella Lucia Marretta3, Roberto Buonaiuto3, Aldo Caltavituro3, Maria Antonietta Zarzana4, Rossana Di Rienzo3, Margherita Tafuro3, Vitantonio Del Deo5, Sabino De Placido1,3, Mario Giuliano1,3, Giovannella Palmieri1
1Rare Tumors Coordinating Center of Campania Region (CRCTR), Naples, Italy;
2Unit of Melanoma, Cancer Immunotherapy and Development Therapeutics, Italian National Cancer Institute-IRCCS Pascale Foundation, Naples, Italy;
3Department of Clinical Medicine and Surgery, University Federico II, Naples, Italy;
4Medical Oncology, A.O. Papardo & Department of Human Pathology, University of Messina, Messina, Italy;
5Clinical Department of Oncology and Hematology, Azienda Ospedaliera Universitaria Policlinico “Federico II”, Naples, Italy
#These authors contributed equally to this work as co-first authors.
Correspondence to: Giovannella Palmieri, MD. Rare Tumors Coordinating Center of Campania Region (CRCTR), Via Sergio pansini 5, Naples 80131, Italy. Email: palmierigiovannella2@gmail.com.
Background: Thymic epithelial tumors (TETs) are rare malignancies. Surgery is the only curative treatment for long-term survival. Patients with locally advanced or metastatic disease should be considered for multimodality treatment with chemotherapy, surgery and radiotherapy. In the last years the immune checkpoint inhibitors (ICIs) have been introduced with success in the therapeutic scenario of thoracic malignancies; however, since the potential association of TETs with autoimmune disorders is well acknowledged, the administration of ICIs has to be carefully evaluated for each patient, as shown in the clinical experience at the University of Naples Federico II, here reported.
Case Description: In 2004, a 33-year-old Caucasian man, was diagnosed with unresectable thymic carcinoma (Masaoka-Koga stage IVA). The patient was treated with several chemotherapy agents, target therapies and radiotherapy. Because of worsening clinical conditions and occurrence of respiratory distress, in 2018, the patient underwent fibro-bronchoscopy with biopsy. Histological examination revealed the presence of a squamous-cell carcinoma with immunohistochemistry profile coherent with a thymic origin and a PDL-1 expression >50%, thus started anti-PD1 therapy (pembrolizumab 200 mg every 3 weeks). After two cycles, due to the worsening of the clinical conditions, metronomic oral Etoposide was added, at dosage of 100 mg/daily 3 week on/1 week off. To highlight that during treatment, for the onset of recurrent respiratory and digestive infections, Good’s syndrome (GS) diagnosis was done. Patient started treatment with intravenous immunoglobulins (IVIgG) 30 mg once a month, obtaining a reduction of the infectious episodes. The combination therapy is still ongoing after 5 years from the start, achieving an impressive long-lasting control disease and a remarkable improvement in patient’s clinical conditions without any relevant adverse effects.
Conclusions: This is the first report about efficacy and safety of the combination therapy of anti-PD1 and oral etoposide in a patient with advanced thymic carcinoma, complicated by GS, then managed with IgG infusion. The onset of GS as potential autoimmune side event of anti-PD1 therapy need to be further elucidated. Since TETs are very rare tumors and clinical studies are difficult to conduct, case reports about the use of new successfully therapeutic strategies must be carefully documented and published.
Keywords: Anti-PD1; etoposide; thymic carcinoma; case report
Acknowledgments
The authors would like to acknowledge the European Reference Network (ERN-EURACAN) as a powerful resource for transnational collaboration in rare cancers. Clinical research activities were performed by E.P. and P.D.P. within the PhD Program in Advanced Biomedical and Surgical Therapies at Department of Clinical Medicine and Surgery, University “Federico II”, Naples, Italy.
Funding: None.
Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://med.amegroups.com/article/view/10.21037/med-23-ab003/coif). M.O. reported speakers fee and travel accommodation from MSD, Novartis, BMS, Sanofi Regeneron, Amgen. P.D.P. reported payment or honoraria for lectures, presentations, speakers’ bureaus, manuscript writing or educational events from Lilly, Gilead, MSD, Roche, Exact Sciences, Novartis, and support for attending meetings and/or travel from Gilead, Lilly, Istituto Gentili, MSD and he was supported by an American-Italian Cancer Foundation Post-Doctoral Research Fellowship, year 2023–2024. S.D.P. reported consulting fees from Astrazeneca, Novartis, Pfizer, Roche, Daiichi Sankyo, Lilly, Clovis, Seagen, GSK, MSD, and payment or honoraria for lectures, presentations, speakers’ bureaus, manuscript writing or educational events from Astrazeneca, Novartis, Pfizer, Roche, Daiichi Sankyo, Lilly, Clovis, Seagen, GSK, MSD. M.G. reported consulting fees from Lilly, Celgene, Novartis, Pfizer, and payment or honoraria for lectures, presentations, speakers’ bureaus, manuscript writing or educational events from Lilly, Celgene, Novartis, Pfizer, Istituto Gentili, Eisai Europe Ltd, Roche. M.G. also reported support for attending meetings and/or travel from Novartis, Pfizer, Roche. The other authors have no conflicts of interest to declare.
Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. All procedures performed in this study were in accordance with the ethical standards of the Ethical Committee of University of Naples Federico II and with the Helsinki Declaration (as revised in 2013). Written informed consent was obtained from the patient for the publication of this case report. A copy of the written consent is available for review by the editorial office of this journal.
Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.
doi: 10.21037/med-23-ab003
Cite this abstract as: Ottaviano M, Parola S, Neola G, Grieco A, Pietroluongo E, De Placido P, Tortora M, Saponaro M, Morra R, Piscopo A, Marretta AL, Buonaiuto R, Caltavituro A, Zarzana MA, Di Rienzo R, Tafuro M, Del Deo V, De Placido S, Giuliano M, Palmieri G. AB003. Unexpected long-lasting control of thymic carcinoma treated with anti-PD1 and oral etoposide: a real-life experience of combination therapy. Mediastinum 2023;7:AB003.
