AB045. Impact of relative dose intensity of platinum-base chemotherapy as first-line treatment in patients with thymic epithelial tumors
Abstract

AB045. Impact of relative dose intensity of platinum-base chemotherapy as first-line treatment in patients with thymic epithelial tumors

Erica Pietroluongo1, Roberto Buonaiuto1, Pietro De Placido1,2, Angelo Luciano1, Margaret Ottaviano3, Rocco Morra4, Marianna Tortora5, Annarita Peddio1, Rosanna Di Rienzo1, Maria Rosaria Saponaro6, Aldo Caltavituro1, Carmine De Angelis1, Grazia Arpino1, Sabino De Placido1, Giovannella Palmieri5, Alberto Servetto1, Roberto Bianco1, Mario Giuliano1

1Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy; 2Department of Advanced Biomedical Sciences, University of Naples Federico II, Napoli, Italy; 3Unit of Melanoma, Cancer Immunotherapy and Development Therapeutics, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, Naples, Italy; 4Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, Naples, Italy; 5Regional Coordinating Center for Rare Tumors (CRCTR) of Campania Region at University Federico II, Naples, Italy; 6SC Oncologia, Osp. S.Andrea -ASL VC, Vercelli, Italy

Correspondence to: Erica Pietroluongo, MD. Department of Clinical Medicine and Surgery, University of Naples Federico II, Via Sergio Pansini 5, Naples 80131, Italy. Email: erica.pietroluongo@unina.it.

Background: International guidelines recommend platinum-based chemotherapy as first-line treatment for advanced thymic epithelial tumors (TETs). According to available data, the objective response rate (ORR) for first-line platinum-based chemotherapy is approximately 50% for thymoma (T) and 20% for thymic carcinoma (TC). To date, no study has evaluated the potential impact on clinical outcome of relative dose intensity (RDI) of platinum-based chemotherapy in TETs patients. The study aims to assess the potential impact on clinical outcomes of RDI of first-line platinum-based chemotherapy.

Methods: A retrospective analysis was performed on patients with advanced TETs who were treated for first-line platinum-based chemotherapy between 2016 and 2022 at the University of Naples Federico II, Italy. Clinical data were extracted from electronic medical records. RDI was calculated as the ratio of delivered to planned chemotherapy dose intensity, categorized as low (l-RDI) if less than 85% or high (h-RDI) if 85% or greater.

Results: A total of 33 patients were enrolled in the study, including 15 (45.45%) with thymoma and 18 (54.55%) with TC. Twenty-two patients received an l-RDI (66%) and eleven h-RDI (33%) of platinum-based chemotherapy. There was no statistically significant correlation found between RDI and objective response rate (ORR) (P=0.66) (Fisher’s exact test). Patients treated with h-RDI had a prolonged time-to next-treatment (TTNT) compared to patients treated with l-RDI (P=0.04, 6.6 vs. 5 months). In addition, TTNT was significantly longer in patients without Good’s syndrome (GS) compared to those with GS (P<0.001, 6.6 vs. 3.8 months). Furthermore, a numerical advantage in overall survival (OS) was observed in patients with h-RDI compared to l-RDI (86.4 vs. 32.2 months, P=0.36).

Conclusions: This is the first study to evaluate RDI of platinum-based chemotherapy in TETs patients. Most patients received reduced platinum-based chemotherapy doses or experienced treatment delays, primarily due to factors such as performance status, comorbidities, or physician choice. Significantly, these data highlight the critical significance of administering the proper chemotherapy doses on schedule in the first-line treatment, whenever feasible, as it substantially influences the clinical outcomes for overall survival.

Keywords: Thymic epithelial tumors (TETs); relative dose intensity (RDI); platinum-based chemotherapy

Acknowledgments

The authors thank the European Reference Network (ERN-EURACAN), which is a powerful resource for transnational collaboration in rare cancers. Clinical research was performed by E.P. and P.D.P. within the PhD Program in Advanced Biomedical and Surgical Therapies at the Department of Clinical Medicine and Surgery, University “Federico II”, Naples, Italy. P.D.P. performed this research as part of the research activities as a PNRR “Fit4MedRob” - RTD-A at the Department of Advanced Biomedical Sciences.

Funding: None.

Footnote

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://med.amegroups.com/article/view/10.21037/med-24-ab045/coif). M.O. reports speakers’ fees and travel accommodations from MSD, Novartis, BMS, Sanofi Regeneron, Amgen. C.D.A. reports an advisory role for Roche, Lilly, Novartis, Astrazeneca, Pfizer, Seagen, Daiichi-Sankyo, Gilead, GSK, speaker fees from Roche, Lilly, Novartis, Pfizer, Seagen, GSK, Gilead, Daiichi-Sankyo, travel grants from Gilead, and research support (to the institution) from Novartis, Gilead, and Daiichi-Sankyo. Roberto Bianco reports fees for lectures and participation on advisory boards from Roche, AstraZeneca, Novartis, Lilly, BMS, MSD, Pfizer. A.S. reports payment or honoraria for lectures, presentations, speakers’ bureaus, or educational events from Lilly, Gilead, MSD, Roche, Novartis, MSD, Janssen, AstraZeneca. He also reports support for attending meetings and/or travel from Bristol-Myers Squibb, AstraZeneca, Janssen, and Daiichi Sankyo. He reports participation on Data Safety Monitoring Boards for MSD and Novartis. MSD. G.A. reports consulting fees, honoraria for lectures, presentations, speakers’ bureaus, and travel support from AstraZeneca, Daiichi Sankyo, Novartis, Roche, Pfizer, Lilly, Gilead, and Seagen. She also reports participation on a Data Safety Monitoring Board for Roche and Novartis. M.G. reports consulting fees from Lilly, Celgene, Novartis, Pfizer; fees for lectures and travel support from Lilly, Celgene, Novartis, Pfizer, Istituto Gentili, Eisai Europe Ltd., Roche. S.D.P. reports consulting fees and lecture fees from Astrazeneca, Novartis, Pfizer, Roche, Daiichi Sankyo, Lilly, Clovis, Seagen, GSK, MSD. P.D.P. is supported by an American-Italian Cancer Foundation Post-Doctoral Research Fellowship, years 2023–2024. 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. The study was conducted in accordance with the Declaration of Helsinki (as revised in 2013). The study was approved by the ethics board of the University of Naples Federico II (approval No. 186/2023), and individual consent for this retrospective analysis was waived.

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-24-ab045
Cite this abstract as: Pietroluongo E, Buonaiuto R, De Placido P, Luciano A, Ottaviano M, Morra R, Tortora M, Peddio A, Di Rienzo R, Saponaro MR, Caltavituro A, De Angelis C, Arpino G, De Placido S, Palmieri G, Servetto A, Bianco R, Giuliano M. AB045. Impact of relative dose intensity of platinum-base chemotherapy as first-line treatment in patients with thymic epithelial tumors. Mediastinum 2024;8:AB045.

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